Chest
Volume 113, Issue 4, April 1998, Pages 883-889
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Clinical Investigations: Surgery
Preoperative Smoking Habits and Postoperative Pulmonary Complications

https://doi.org/10.1378/chest.113.4.883Get rights and content

Objective

To examine the effect of preoperative smoking behavior on postoperative pulmonary complications.

Setting

The Veterans Administration Medical Center, Syracuse, NY.

Participants

Patients scheduled for noncardiac elective surgery (n=410).

Measurements and results

Smoking status was determined by self-report. Postoperative pulmonary complications were determined by systematic extraction of medical record data. Postoperative pulmonary complications occurred in 31 of 141 (22.0%) current smokers, 24 of 187 (12.8%) past smokers, and 4 of 82 (4.9%) never smokers. The odds ratio (OR) for developing a postoperative pulmonary complication for current smokers vs never smokers was 5.5 (95% confidence interval [CI], 1.9 to 16.2) and 4.2 (95% CI, 1.2 to 14.8) after adjustment for type of surgery, type of anesthesia, abnormal chest radiograph, chronic cough, history of pulmonary disease, history of cardiac disease, history of COPD, education level, pulmonary function, body mass index, and age. Current smokers who reported reducing cigarette consumption prior to surgery were more likely to develop a complication compared with those who did not (adjusted OR=6.7, 95% CI, 2.6 to 17.1).

Conclusions

Current smoking was associated with a nearly sixfold increase in risk for a postoperative pulmonary complication. Reduction in smoking within 1 month of surgery was not associated with a decreased risk of postoperative pulmonary complications.

Section snippets

Design/Subjects

A prospective cohort study was conducted between 1990 and 1992 at the Veterans Administration Medical Center in Syracuse, NY. Potential subjects were identified by systematic review of daily admission logs. Patients scheduled for elective general, orthopedic, urologic, or cardiovascular surgery were interviewed at the time of hospital admission. To be eligible, a potential subject must have been scheduled to receive general or spinal anesthesia. Patients scheduled to undergo ear, nose, throat,

Sample Charactenstics

Characteristics of the study participants are listed in Table 1. Current smokers comprised 34.4% (n=141) of the study population, 45.6% (n=187) were past smokers, and 20% (n=82) were never smokers. The vast majority of subjects were male and white. Current smokers were significantly younger than past or never smokers. They were also less likely to be married, had lower incomes, and lower BMI values when compared with both past and never smokers. As expected, current smokers achieved lower peak

DISCUSSION

We demonstrated that current smokers experienced significantly more postoperative pulmonary complications than past or never smokers. This finding is consistent with results from several other studies.8, 9, 10, 11, 12, 13, 14, 15, 16 Wellman and Smith18 found that the incidence of postoperative pulmonary complications following upper abdominal and thoracic surgery was doubled in cigarette smokers, and that smoking ≥20 cigarettes per day was associated with a fourfold increase in postoperative

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