Preoperative smoking habits and postoperative pulmonary complications. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial Effects of a Perioperative Smoking Cessation Intervention on Postoperative Complications: A Randomized Trial Impact of lifestyle on perioperative smoking cessation and postoperative complication rate. Short‐term pre‐operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation Increasing smoking cessation care in a preoperative clinic: a randomized controlled trial. The Effectiveness of a Perioperative Smoking Cessation Program: A Randomized Clinical Trial Monitoring of exhaled carbon monoxide to promote preoperative smoking abstinence. An evaluation of preoperative methods of preventing postoperative pulmonary complications. Postoperative pulmonary complications after gynecologic surgery. A prospective study of tobacco smoking as a predictor of complications in general surgery. The effectiveness of pre‐operative advice to stop smoking: a prospective controlled trial Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy Lack of correlation between smoking status and early postoperative outcome following valve surgery.
OBJECTIVE To examine the effect of preoperative smoking behavior on postoperative pulmonary complications . DESIGN Prospect i ve cohort study . 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 BACKGROUND Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers . Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement . METHODS We did a r and omised trial in three hospitals in Denmark . 120 patients were r and omly assigned 6 - 8 weeks before scheduled surgery to either the  control ( n=60 ) or smoking intervention ( 60 ) group .  Smoking intervention was counselling and nicotine replacement therapy , and either smoking cessation or at least 50 % smoking reduction . An assessor , who was masked to the intervention , registered the occurrence of cardiopulmonary , renal , neurological , or surgical complications and duration of hospital admittance . The main analysis was by intention to treat . FINDINGS Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled . Thus , 52 and 56 patients , respectively , were analysed for outcome . The overall complication rate was 18 % in the smoking intervention group and 52 % in controls ( p=0.0003 ) . The most significant effects of intervention were seen for wound-related complications ( 5 % vs 31 % , p=0.001 ) , cardiovascular complications ( 0 % vs 10 % , p=0.08 ) , and secondary surgery ( 4 % vs 15 % , p=0.07 ) . The median length of stay was 11 days ( range 7 - 55 ) in the intervention group and 13 days ( 8 - 65 ) in the control group . INTERPRETATION An effective smoking intervention programme 6 - 8 weeks before surgery reduces postoperative morbidity , and we recommend , on the basis of our results , this programme be adopted Objective : To determine whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications . Summary Background Data : Complications are a major concern after elective surgery and smokers have an increased risk . There is insufficient evidence concerning how the duration of preoperative smoking intervention affects postoperative complications . Methods : A r and omized controlled trial , conducted between February 2004 and December 2006 at 4 university-affiliated hospitals in the Stockholm region , Sweden . The outcome assessment was blinded . The follow-up period for the primary outcome was 30 days . Eligibility criteria were active daily smokers , aged 18 to 79 years . Of the 238 patients assessed , 76 refused participating , and 117 men and women undergoing surgery for primary hernia repair , laparoscopic cholecystectomy , or a hip or knee prosthesis were enrolled . Intervention : Smoking cessation therapy with individual counseling and nicotine substitution started 4 weeks before surgery and continued 4 weeks postoperatively . The control group received st and ard care . The main outcome measure was frequency of any postoperative complication . Results : An intention-to-treat analysis showed that the overall complication rate in the control group was 41 % , and in the intervention group , it was 21 % ( P = 0.03 ) . Relative risk reduction for the primary outcome of any postoperative complication was 49 % and number needed to treat was 5 ( 95 % CI , 3–40 ) . An analysis per protocol showed that abstainers had fewer complications ( 15 % ) than those who continued to smoke or only reduced smoking ( 35 % ) , although this difference was not statistically significant . Conclusion : Perioperative smoking cessation seems to be an effective tool to reduce postoperative complications even if it is introduced as late as 4 weeks before surgery OBJECTIVE The aim was to examine to what extent lifestyle , education , social support , and comorbidity predict the ability of perioperative smoking cessation , and are associated with the development of important postoperative complications . DESIGN The design was a r and omized clinical trial . SETTING University hospitals in Copenhagen , Denmark , were the setting s. PARTICIPANTS AND METHODS One hundred twenty patients scheduled for primary elective hip or knee arthroplasty were r and omized to either smoking intervention or st and ard care .  Tobacco and alcohol consumption , exercise and eating habits , level of education , matrimonial status , and the  presence of social support  were registered . The data gathered concerned smoking cessation/reduction and severe postoperative morbidity . RESULTS Men and patients with a good social network were more likely to successfully quit smoking . Smoking intervention successfully reduced the incidence of postoperative complications , as did weekly exercise exceeding 4 h , and having a high education level . CONCLUSIONS This study emphasizes that smoking intervention programs in health care setting s are highly effective in reducing postoperative risks in hip and knee arthroplasty Background Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers . We tested the hypothesis that short‐term pre‐operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications BACKGROUND Smokers are more prone to develop postoperative complications . Smoking cessation intervention beginning 4 - 8 weeks prior to surgery improves the postoperative outcome . Cancer patients , however , often undergo surgery less than 4 weeks after diagnosis . The primary objective of this study was therefore to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation . METHODS A r and omized controlled multicentre trial with blinded outcome assessment conducted at 3 hospitals in Denmark . One hundred and thirty patients were r and omly assigned to brief smoking intervention ( n = 65 ) or st and ard care ( n = 65 ) . The intervention followed the principles of motivational interviewing and included personalized nicotine replacement therapy aim ed at supporting smoking cessation from 2 days before to 10 days after surgery . RESULTS The overall postoperative complication rate ( including seroma requiring aspiration ) was 61 % in both groups risk ratio ( RR ) 1.00 ( 95 % CI 0.75 - 1.33 ) . The wound complication rate was 44 % versus 45 % . The effect on perioperative smoking cessation was modest , 28 % intervention versus 11 % control group patients , RR 2.49 ( 95 % CI 1.10 - 5.60 ) . There was no effect on smoking cessation at 12 months , 13 % versus 9 % . CONCLUSIONS Brief smoking intervention administered shortly before breast cancer surgery modestly increased self-reported perioperative smoking cessation without having any clinical impact on postoperative complications . The study adds to the body of evidence indicating that brief intervention has no clinical importance for surgical patients in regard to postoperative morbidity . Future studies should be design ed to determine the optimal time of smoking cessation before surgery The association between preoperative smoking cessation and postoperative pulmonary morbidity was studied prospect ively in 200 consecutive patients undergoing an elective coronary artery bypass surgical procedure .  Detailed respiratory , cardiovascular , and smoking histories were elicited . Preoperative arterial blood gas analyses and bedside spirometry were performed . Urinary cotinine levels were measured to verify smoking histories . During spirometry , severe angina developed in seven patients , who were hence excluded from the study ; one patient died of hemorrhage intraoperatively . An observer unaware of patients ' preoperative histories assessed the remaining 192 patients throughout the intraoperative and postoperative periods for pulmonary complications . Postoperative pulmonary complications occurred in a third of the current smokers . Patients who had stopped smoking for 2 months or less had a pulmonary complication rate almost 4 times that of patients who had stopped for more than 2 months ( 57.1 % versus 14.5 % ) . Patients who had stopped smoking for more than 6 months had rates similar to those who had never smoked ( 11.1 % and 11.9 % , respectively ) . Preoperative pulmonary dysfunction , increased pack-years of smoking , prolonged surgical time , and the use of enflurane  were independently associated with postoperative pulmonary morbidity ( P less than 0.05 ) . We concluded that smoking cessation should occur at least 2 months preoperatively to maximize the reduction of postoperative respiratory complications Background Daily smokers and hazardous drinkers are high-risk patients , developing 2 - 4 times more complications after surgery . Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate . The patients ' preoperative contact with the surgical departments might be too brief for the hospital to initiate these programmes . Therefore , it was relevant to evaluate a new clinical practice which combined the general practitioner 's ( GP ) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway . Methods The design was an exploratory prospect i ve trial . The outcome measured was the number of patients referred to a  preoperative smoking and alcohol cessation programme  at the same time as being referred for elective surgery by their GP . The participants consisted of 72 high-risk patients who were referred for elective surgery by 47 local participating GPs . The GPs , nurses , and specialists in internal medicine , prehabilitation and surgery developed new clinical practice guidelines based on the literature and interviews with 11 local GPs about the specific barriers for implementing a smoking and alcohol cessation programme . The role of the GP was to be the gatekeeper : identifying daily smokers and hazardous drinkers when referring them to surgery ; h and ing out information on risk reduction ; and referring those patients identified to a preoperative smoking and alcohol cessation programme . The role of the hospital was to contact these patients to initiate smoking and alcohol cessation at the hospital out-patient clinic for life-style intervention . Results The GPs increased their referral to the smoking and alcohol cessation programme from 0 % to 10 % ( 7/72 patients ) in the study period . Conclusion The effect of the study was limited in integrating the efforts of primary care providers and hospital surgical departments in increasing the up-take of preoperative smoking and alcohol cessation programmes aim ed at smokers and harmful drinkers referred for surgery . New strategies for cooperation between GPs and surgical departments are urgently needed . Trial registration J.nr . 2005 - 54 - 1781 in Danish Data Protection Agency.J.nr . 07 268136 in Scientific Ethical Committee for Copenhagen and Frederiksberg Municipalities BACKGROUND Evidence suggests that preoperative clinics , like other hospital outpatient clinics and inpatient wards , fail to systematic ally provide smoking cessation care to patients having planned surgery . METHODS The aim of the study was to assess the efficacy , acceptability , and cost of a multifaceted intervention to facilitate the provision of comprehensive smoking cessation care to patients attending a preoperative clinic . Two hundred ten smoking patients attending a preoperative clinic at a major teaching hospital in Australia took part in the study . One hundred twenty-four patients were r and omly assigned to an  experimental group and 86 patients to a usual cessation care group .  A multifaceted intervention was developed that included the use of opinion leaders , consensus processes , computer-delivered cessation care , computer-generated prompts for care provision by clinic staff , staff training , and performance feedback . RESULTS Ninety-six percent of experimental group patients received behavioral counseling and tailored self-help material . Experimental group patients were significantly more likely than usual care patients to report receiving brief advice by nursing ( 79 % vs. 47 % ; P < 0.01 ) and anaesthetic ( 60 % vs. 39 % ; P < 0.01 ) staff . Experimental group patients who were nicotine dependent were also more likely to be offered preoperative nicotine replacement therapy ( NRT ) ( 82 % vs. 8 % ; P < 0.01 ) and be prescribed postoperative NRT ( 86 % vs. 0 % ; P < 0.01 ) . The multifaceted intervention was found to be acceptable by staff . CONCLUSION A multifaceted clinical practice change intervention may be effective in improving the delivery of smoking cessation care to preoperative surgical patients BACKGROUND : Cigarette smoking by surgical patients is associated with increased complications , particularly perioperative respiratory problems and poor wound healing . In this study , we sought to determine whether a pragmatic perioperative smoking cessation intervention design ed for a busy preadmission clinic would be successful in reducing smoking rates and intraoperative and immediate postoperative complications . METHODS : This r and omized controlled trial was conducted at a university-affiliated hospital in London , Ontario , Canada . Patients seen in the preadmission clinic at least 3 weeks preoperatively were r and omized to either the control group ( 84 patients ) or the intervention group ( 84 patients ) . The control group received no specific smoking cessation intervention . The intervention group received ( 1 ) brief counseling by the preadmission nurse , ( 2 ) brochures on smoking cessation , ( 3 ) referral to the Canadian Cancer Society ’s Smokers ’ Helpline , and ( 4 ) a free 6-week supply of transdermal nicotine replacement therapy . All outcome assessors and caregivers on the operative day were blinded to group assignment . The primary outcome was the rate of smoking cessation as confirmed by exhaled carbon monoxide breath test . Secondary outcomes included perioperative complications and smoking status at 30 days postoperatively . RESULTS : Between October 2010 and April 2012 , 168 patients were recruited into the study .  Smoking cessation occurred in 12 patients ( 14.3 % ) in the intervention group as compared with 3 patients ( 3.6 % ) in the control group ( relative risk 4.0 ; 95 % confidence interval [ CI ] , 1.2–13.7 ; P = 0.03 ) . The overall rate of combined intraoperative and immediate postoperative complications was not significantly different between intervention and control groups ( 13.1 % and 16.7 % , respectively ; relative risk 0.79 ; 95 % CI , 0.38–1.63 ; P = 0.67 ) . At follow-up 30 days postoperatively , smoking cessation was reported in 22 patients ( 28.6 % ) in the intervention group compared with 8 patients ( 11 % ) in controls ( relative risk 2.6 ; 95 % CI , 1.2–5.5 ; P = 0.008 ) . CONCLUSIONS : One of the objections to widespread use of smoking cessation interventions in the preadmission clinic is that it is too labor-intensive . The results of this study show that a smoking cessation intervention , design ed to minimize additional use of physician or nursing time , results in decreased smoking rates on the day of surgery and promotes abstinence 30 days postoperatively OBJECTIVE Brief preoperative abstinence from cigarette smoking reduces risk for perioperative complications in surgical patients . This study tested the hypothesis that the efficacy of brief advice recommending abstinence the morning of surgery would be increased if patients were informed that exhaled carbon monoxide ( CO ) levels would be monitored to assess compliance . METHOD Cigarette smokers scheduled for elective surgery were r and omized to 2 groups . Subjects in both groups received brief advice ( BA ) recommending smoking abstinence on the morning of surgery . The CO-informed + BA group was also told that their smoking status would be checked before surgery using exhaled CO monitoring ; the other group ( BA only ) was not . RESULTS CO levels on the morning of surgery were not significantly different in the CO-informed + BA ( n = 80 ) and BA-only groups ( n = 84 ; M = 9.7 , SD = 8.0 , and M = 9.3 , SD = 6.6 parts per million ( ppm ) , respectively , p = .67 ) . When the data from both groups were combined and compared with data from 506 additional surgical patients receiving only usual care , CO levels were significantly higher in those patients receiving usual care . CONCLUSIONS Informing patients that their smoking status would be checked the morning of surgery by CO monitoring does not further increase the efficacy of BA to abstain the morning of surgery The effectiveness of three current regimes of preoperative respiratory care in reducing postoperative respiratory complications following herniorrhaphy  was studied prospect ively . No smoking for five days plus intensive physiotherapy , five days no smoking , and routine hospital admission two days preoperatively were the regimes . Clinical , bacteriological , chest X-ray , blood gas and respiratory function test data were the criteria for assessment . The same surgical and anaesthetic team performed each operation . No statistical difference between the groups for pulmonary complications was noted . A significant correlation was found between the preoperative vital capacity and arterial pO2 ; also between the preoperative forced expiratory volume in one second-vital capacity ratio with the postoperative arterial pO2 OBJECTIVE Investigate the frequency of , and risks for postoperative  pulmonary complications after surgery for non-malignant gynecologic disorders . METHOD A retrospective component included medical record data for one year . A prospect i ve component enrolled 300 patients consecutively who were scheduled for gynecologic surgeries .  RESULT Postoperative pulmonary complications occurred in 1.22 % of 328 open abdominal procedures in the retrospective study , and 2.16 % of 232 in the prospect i ve study . Pooling the data yielded a frequency estimate of 1.61 % . Mean hospital length of stay ( pooled data ) increased 1.75 days in those with postoperative pulmonary complications . Smoking was the only significant risk factor ( relative risk=3.9 using pooled data ) . CONCLUSION Postoperative pulmonary complications after surgery for non-malignant gynecologic disorders are infrequent but increase hospital length of stay . Smokers are at increased risk OBJECTIVE To analyze whether  tobacco smoking  is related to nosocomial infection , admission to the intensive care unit , in-hospital death , and length of stay . DESIGN A prospect i ve cohort study . SETTING The Service of General Surgery of a tertiary-care hospital . PATIENTS A consecutive series of patients admitted for more than 1 day ( N = 2,989 ) . RESULTS Sixty-two ( 2.1 % ) patients died and 503 ( 16.8 % ) acquired a nosocomial infection , of which 378 ( 12.6 % ) were surgical site and 44 ( 1.5 % ) were lower respiratory tract . Smoking ( mainly past smoking ) was associated with a worse health status ( eg , longer preoperative stay and higher American Society of Anesthesiologists score ) . A long history of smoking ( > or = 51 pack-years ) increased postoperative admission to the intensive care unit ( adjusted odds ratio [ OR ] = 2.86 ; 95 % confidence interval [ CI95 ] , 1.21 to 6.77 ) and in-hospital mortality ( adjusted OR = 2.56 ; CI95 , 1.10 to 5.97 ) . There was no relationship between current smoking and surgical-site infection ( adjusted OR = 0.99 ; CI95 , 0.72 to 1.35 ) , whereas a relationship was observed between past smoking and surgical-site infection ( adjusted OR = 1.46 ; CI95 , 1.02 to 2.09 ) . Current smoking and , to a lesser degree , past smoking augmented the risk of lower respiratory tract infection ( adjusted OR = 3.21 ; CI95 , 1.21 to 8.51 ) . Smokers did not undergo additional surgical procedures more frequently during hospitalization . In the multivariate analysis , length of stay was similar for smokers and nonsmokers . CONCLUSION Smoking increases in-hospital mortality , admission to the intensive care unit , and lower respiratory tract infection , but not surgical-site infection . Deleterious effects of smoking are also observed in past smokers and they can not be counteracted by hospital cessation programs Patients who smoke cigarettes suffer increased postoperative morbidity . A prospect i ve , controlled trial was design ed to evaluate the effectiveness of written pre‐operative advice to stop smoking before admission for elective surgery and to record the duration of abstinence  immediately before the operation . Although the advice was ineffective in persuading patients to stop smoking , it was associated with a reduction in the amount of tobacco consumed . Nicotine and carbon monoxide have important short‐term adverse effects but 15 % of all patients continued to smoke within an hour of surgery . If patients are unable to give up cigarette smoking completely , it is still worthwhile stopping on admission to hospital Background / Aims : Patients with postoperative pulmonary complications after esophagectomy often have increased mortality . The purpose of the study was to examine the efficacy of preventing postoperative pulmonary complications by an intensive preoperative respiratory rehabilitation ( PR ) program for esophageal cancer patients . Methods : This study was a prospect i ve r and omized controlled study . Thirty patients in the PR group and 30 patients in the no preoperative respiratory rehabilitation ( NPR ) group were included . The PR group received preoperative rehabilitation for more than 7 days , while the NPR group did not receive any preoperative rehabilitation . All patients underwent postoperative rehabilitation from the first postoperative day . The postoperative pulmonary complications were evaluated using the Clavien-Dindo classification ( CDC ) and the Utrecht Pneumonia Scoring System ( UPSS ) . Results : The CDC grade in the PR group was significantly lower than that in the NPR group ( p = 0.014 ) . The UPSS score in the PR group was significantly lower than that in the NPR group at postoperative day 1 ( p = 0.031 ) . In the multivariate analysis , NPR was an independent risk factor for postoperative pulmonary complications greater than CDC grade II ( OR : 3.99 , 95 % CI : 1.28 - 12.4 , p = 0.017 ) . Conclusions : This study showed that the intensive PR program was capable of reducing the postoperative pulmonary complications in esophageal cancer patients BACKGROUND We sought to assess the effect of smoking on early outcome following valve surgery . METHODS This is a retrospective review of a prospect ively collected departmental data base of all patients who underwent isolated aortic and /or mitral valve surgery ( replacement and /or repair ) . Our cohort consisted of 590 patients stratified into three groups :  current smokers  ( n = 94 ) ,  ex-smokers  ( n = 243 ) , and nonsmokers ( n = 253 ) . RESULTS There were no significant differences in the in-hospital mortality between the three groups . Likewise , the length of both hospital and intensive care unit stays were similar among the three groups with a similar rate of postoperative complications . These findings remained statistically not significant , even after adjusting for potential confounders such as age , gender , etc . CONCLUSION Smoking does not seem to be associated with an increased early postoperative risk in patients undergoing valve surgery . However , because of the known effect of smoking on the risk of cardiovascular disease and because the effect of smoking on long-term survival in patients undergoing valve surgery remains unknown , patients should still be encouraged to quit smoking
Preoperative smoking status was not observed to be associated with postoperative mortality , cardiovascular complications , bleedings , anastomotic leakage , or allograft rejection .
CONCLUSIONS Preoperative smoking was found to be associated with an increased risk of the following postoperative complications : general morbidity , wound complications , general infections , pulmonary complications , neurological complications , and admission to the intensive care unit
OBJECTIVE To systematic ally review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type .
BACKGROUND The conclusions of studies examining the association between preoperative smoking and postoperative complications are inconsistent , thus there is a need for a review and meta- analysis to summarize the existing evidence .