Chest
Volume 120, Issue 3, September 2001, Pages 705-710
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Clinical Investigations
Smoking
Relationship Between the Duration of the Preoperative Smoke-Free Period and the Incidence of Postoperative Pulmonary Complications After Pulmonary Surgery

https://doi.org/10.1378/chest.120.3.705Get rights and content

Abstract

Study objective

To examine the relationship between the duration of the preoperative smoke-free period and the development of postoperative pulmonary complications (PPCs) in patients who underwent pulmonary surgery, and the optimal timing of quitting smoking.

Setting

Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

Patients

Two hundred eighty-eight consecutive patients who underwent pulmonary surgery between January 1997 and December 1998.

Measurements and results

We collected information on the preoperative characteristics, intraoperative conditions, and occurrence of PPCs by reviewing the medical records. Study subjects were classified into four groups based on their smoking status. A current smoker was defined as one who smoked within 2 weeks prior to the operation. Recent smokers and ex-smokers were defined as those whose duration of abstinence from smoking was 2 to 4 weeks and > 4 weeks prior to the operation, respectively. A never-smoker was defined as one who had never smoked. The incidence of PPCs among the current smokers and recent smokers was 43.6% and 53.8%, respectively, and each was higher than that in the never-smokers (23.9%; p < 0.05). The moving average of the incidence of PPCs gradually decreased in patients whose smoke-free period was 5 to 8 weeks or longer. After controlling for sex, age, results of pulmonary function tests, and duration of surgery, the odds ratios for PPCs developing in current smokers, recent smokers, and ex-smokers in comparison with never-smokers were 2.09 (95% confidence interval [CI], 0.83 to 5.25), 2.44 (95% CI, 0.67 to 8.89), and 1.03 (95% CI, 0.47 to 2.26), respectively.

Conclusions

These findings indicate that preoperative smoking abstinence of at least 4 weeks is necessary for patients who undergo pulmonary surgery, to reduce the incidence of PPCs.

Section snippets

Design/Subjects

The study subjects were 288 consecutive patients who underwent a pulmonary surgical procedure at our institution between January 1997 and December 1998. By reviewing their medical records, we ascertained the preoperative and intraoperative factors, and whether PPCs occurred in each subject. The relationship between these factors and the incidence of PPCs was examined. This retrospective cohort study was approved by the Ethics Committee at Osaka Medical Center for Cancer and Cardiovascular

Characteristics of the Study Subjects in Each Group According to Smoking Habit

In the four groups, female patients comprised the majority only among the never-smokers. The age, distribution of ASA physical status, BMI, and smoking consumption of the four groups were similar (Table 1). The percentages of current smokers and ex-smokers with obstructive pulmonary disease according to the pulmonary function test result (FEV1 < 70%) were higher than the percentage in the never-smokers. The distribution of performed operations was similar among the four groups. The mean length

Discussion

This study revealed that smoking was an independent risk factor for PPCs developing in patients who underwent pulmonary surgery, and that smoking cessation prior to the surgery reduced the risk for PPC development. The moving average analysis indicated that the risk for developing a PPC started to decline in patients who stopped smoking 5 to 8 weeks prior to the surgery, and that the risk for a PPC developing in patients whose preoperative smoke-free period was > 10 weeks was similar to that in

Conclusion

Our retrospective cohort study indicated that preoperative smoking cessation reduced the risk of a PPC developing in patients who underwent pulmonary surgery, and that smoking cessation should occur at least 4 weeks prior to the surgery to lower the risk for PPCs. However, many smokers continue to smoke up to the time of surgery despite knowing the disadvantages of doing so. Thus, we urge the development of an effective cessation program for outpatients to obtain the necessary length of smoking

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This work was performed at Osaka Medical Center For Cancer and Cardiovascular Diseases.

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