Smoking Signals Big Surgery Risks

Kicking tobacco habit before surgery can cut cardiovascular and respiratory complications

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Surgery tends to make the body weaker and more vulnerable. So before being wheeled into the operating room, it's advisable to be in the best possible health.

A new study suggests that stopping smoking well in advance of a major operation reduced heightened post-operative risks of serious and sometimes life-threatening problems such as heart attacks, strokes and pneumonia.

"Quit smoking before surgery."

Khaled M. Musallam, MD, PhD, an internist and professor at American University of Beirut Medical Center in Beirut, Lebanon, was the study's main researcher.

The research team investigated what happened during the 30 days immediately after surgery for more than 607,000 patients. Of that group, 125,192 patients had been active smokers and 78,763 were ex-smokers. The number of people who never smoked was 403,603. 

Of current smokers, 2,200 patients died during the month after surgery and 1,636 former smokers died during that period. Though the research focused on current and former smokers, it also showed that of the 403,603 patients who had never smoked, 6,194 died within those 30 days. 

Regarding the focus of their investigation, however, the researchers found that being a current smoker was associated with higher risks of post-surgery death. Being a former smoker was not associated with those death risks.

In addition, while current smokers and former smokers both faced the risk for heart attack, stroke and major respiratory problems after surgery, the risk was milder for ex-smokers than current ones. 

Heart attack, stroke or some other cardiovascular complication was experienced by 1,817 current smokers and 1,416 former smokers. That meant, the researchers wrote, that, compared to those who never smoked, current smokers' odds for such complications were 1.65 times higher. Compared to those who never smoked, ex-smokers' odds for such complications were 1.2 times higher.

Compared to people who never smoked, the odds were 1.45 times higher that current smokers would develop pneumonia, have to be placed on a breathing ventilator or experience other major respiratory complications. For ex-smokers the odds, compared to those of people who never smoked, were 1.13 times higher. That translated into 14,105 current smokers having respiratory complications and 8,912 former smokers suffering such complications.

The researchers said there was no significant difference in post-surgical blood clots or circulatory problems experienced by the two groups.

These findings prompted the study authors to conclude that quitting smoking at least 12 months before major surgery eliminates what otherwise would be increased risks of dying after the procedure. Quitting also cut the risks of serious cardiovascular or respiratory problems, they wrote. 

Further, the researchers wrote, "Studies show that hospitals do not consistently provide smoking cessation services to their hospitalized patients, and in most cases these services are restricted to adults admitted for acute [heart attack], congestive heart failure, or pneumonia. Our study should increase awareness of the detrimental effects of smoking, and the benefits of its cessation on morbidity and mortality in the surgical setting.” 

In a press release, the researchers also said, "These findings should be carried forward to evaluate the value and cost effectiveness of intervention in [the hospital] setting."

Study participants had undergone surgery at non-US Department of Veterans Affairs hospitals in the United States, Canada, Lebanon and the United Arab Emirates during 2008 and 2009.

Patient records, which the researchers reviewed, were selected from the American College of Surgeons National Surgical Quality Improvement Program database. Patients' surgeons also were interviewed.

Average patient age was 55.7 years. Roughly 42 percent of the group was male.

Each year there are 500,000 smoking-related deaths in the United States, which also spends about $200 billion annually on medical care for people who smoke, the researchers wrote, citing one of the reasons for their investigation. 

The study was published June 19 in the JAMA Surgery.

The researchers disclosed that they had no financial investments or other involvements that would affect their study's design or outcomes.

Review Date: 
June 17, 2013
Last Updated:
August 2, 2013