Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery: Smokers versus Nonsmokers

Background Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers. Methods The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge ± positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery. Results Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8%vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03–2.84;P = 0.038) and wound infection (3.6%vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58–175;P = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications. Conclusions Smoking was associated with an increased risk of respiratory complications and postoperative wound infection in ambulatory surgery patients. These findings warrant increased efforts at promoting smoking avoidance and cessation.

[1]  D. Cockcroft,et al.  Increased nonspecific bronchial reactivity in cigarette smokers with normal lung function. , 2015, The American review of respiratory disease.

[2]  A. Møller,et al.  Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial , 2002, The Lancet.

[3]  A. Matsuki,et al.  Recovery of Intraoperative Microbicidal and Inflammatory Functions of Alveolar Immune Cells after a Tobacco Smoke-free Period , 2001, Anesthesiology.

[4]  L. Moores.  Smoking and postoperative pulmonary complications. An evidence-based review of the recent literature. , 2000, Clinics in chest medicine.

[5]  W E Wilkinson,et al.  The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs , 1999, Infection Control & Hospital Epidemiology.

[6]  S. Mannino,et al.  Exposure to Environmental Tobacco Smoke and the Risk of Adverse Respiratory Events in Children Receiving General Anesthesia , 1998, Anesthesiology.

[7]  L. Mosca,et al.  Preoperative smoking habits and postoperative pulmonary complications. , 1998, Chest.

[8]  M. Georgieff,et al.  Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia , 1997, Acta anaesthesiologica Scandinavica.

[9]  A. Kurz,et al.  Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. , 1996, The New England journal of medicine.

[10]  J. S. Church,et al.  Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study. , 1996, Gut.

[11]  W. Kinnear,et al.  Effects of passive and active smoking on induction of anaesthesia. , 1994, British journal of anaesthesia.

[12]  H. Friedman,et al.  The importance of measuring cotinine levels to identify smokers in clinical trials , 1994, Clinical pharmacology and therapeutics.

[13]  Ronald M. Jones,et al.  The effectiveness of pre‐operative advice to stop smoking: a prospective controlled trial , 1993, Anaesthesia.

[14]  T. Schreiber,et al.  Bronchial mucus transport in chronic smokers and nonsmokers during general anesthesia. , 1993, Journal of clinical anesthesia.

[15]  P. Silverstein.  Smoking and wound healing. , 1992, The American journal of medicine.

[16]  Alan D. Lopez,et al.  Mortality from tobacco in developed countries: indirect estimation from national vital statistics , 1992, The Lancet.

[17]  A. Tait,et al.  Changes in arterial oxygen saturation in cigarette smokers following general anaesthesia. , 1991, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[18]  R. Borland,et al.  Are doctors doing enough to stop their patients smoking? , 1989, The Medical journal of Australia.

[19]  C. Callander.  Smoking and anaesthesia , 1987, Anaesthesia.

[20]  Holman Cd,et al.  Premature adult mortality and short-stay hospitalization in Western Australia attributable to the smoking of tobacco, 1979-1983. , 1986 .

[21]  C. Holman,et al.  Premature adult mortality and short‐stay hospitalization in Western Australia attributable to the smoking of tobacco, 1979‐1983 , 1986, The Medical journal of Australia.

[22]  R. M. Jones,et al.  Smoking and anesthesia: preoperative abstinence and perioperative morbidity. , 1984, Anesthesiology.

[23]  J. Tinker,et al.  Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients. , 1984, Anesthesiology.

[24]  W. C. Ball,et al.  A comparison of pulmonary function in male smokers and nonsmokers. , 1976, The American review of respiratory disease.

[25]  R. M. Shick,et al.  THE CARDIOVASCULAR EFFECTS OF SMOKING WITH SPECIAL REFERENCE TO HYPERTENSION , 1960, Annals of the New York Academy of Sciences.

[26]  Aniel,et al.  PERIOPERATIVE NORMOTHERMIA TO REDUCE THE INCIDENCE OF SURGICAL-WOUND INFECTION AND SHORTEN HOSPITALIZATION , 2000 .

[27]  J B Forrest,et al.  Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. , 1992, Anesthesiology.