Postoperative intensive care admittance: The role of tobacco smoking

Background: Smokers have been shown to have increased risk of intraoperative pulmonary complications and of a wide range of postoperative complications, but an increased risk of postoperative intensive care admittance has not yet been described. The aim of this study was to estimate the risk of pulmonary complications and postoperative intensive care admittance in smokers and non-smokers in a general and orthopaedic surgical population. Methods: A total of 4725 surgical patients were assessed. The following information was noted: age, sex and smoking status, history of heart and lung disease, ASA classification, type of anaesthesia, intensive care admittance and postoperative pulmonary or cardiovascular complications. A logistic regression model was used to determine the probability of intensive care admittance and pulmonary complications as a function of smoking status, age, and chronic heart and lung disease. Results: Of the patients, 39.9% were smokers, 45.5% were nonsmokers and in 14.6% of the cases smoking status was unspecified. Postoperative intensive care admittance and pulmonary complications were found in 2.0% and 4.3% of the patients, respectively. Non-smokers were more often female (P<0.01), and smokers had a higher incidence of emergency surgical procedures (P<0.05). When applying multiple regression analysis, we found that smoking, age >65 years, and a history of chronic lung disease increased the risk of unplanned intensive care admittance (odds ratio 1.55, 12.52 and 2.73). Conclusion: Our results indicate a relationship between a history of tobacco smoking and postoperative intensive care admittance.