Introduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. Conclusion: The occurrence of PPCs in smokers is not different from non–smokers. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). Prior presentation: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.
Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries / Dorland, Galina; Saadat, W.; Van Meenen, David M. P.; Neto, Ary Serpa; Hiesmayr, Michael; Hollmann, Markus W.; Mills, Gary H.; Vidal Melo, Marcos F.; Putensen, Christian; Schmid, Werner; Severgnini, Paolo; Wrigge, Hermann; De Abreu, Marcelo Gama; Schultz, Marcus J.; Hemmes, Sabrine N. T.; Kroell, Wolfgang; Metzler, Helfried; Struber, Gerd; Wegscheider, Thomas; Gombotz, Hans; Hiesmayr, Michael; Schmid, Werner; Urbanek, Bernhard; Kahn, David; Momeni, Mona; Pospiech, Audrey; Lois, Fernande; Forget, Patrice; Grosu, Irina; Poelaert, Jan; Van Mossevelde, Veerle; Van Malderen, Marie-Claire; Dylst, Dimitri; Van Melkebeek, Jeroen; Beran, Maud; De Hert, Stefan; De Baerdemaeker, Luc; Heyse, Bjorn; Van Limmen, Jurgen; Wyffels, Piet; Jacobs, Tom; Roels, Nathalie; De Bruyne, Ann; Van De Velde, Stijn; Leva, Brigitte; Damster, Sandrine; Plichon, Benoit; Juros-Zovko, Marina; Djonoviċ-Omanoviċ, Dejana; Pernar, Selma; Zunic, Josip; Miskovic, Petar; Zilic, Antonio; Kvolik, Slavica; Ivic, Dubravka; Azenic-Venzera, Darija; Skiljic, Sonja; Vinkovic, Hrvoje; Oputric, Ivana; Juricic, Kazimir; Frkovic, Vedran; Kopic, Jasminka; Mirkovic, Ivan; Karanovic, Nenad; Carev, Mladen; Dropulic, Natasa; Saric, Jadranka Pavicic; Erceg, Gorjana; Dvorscak, Matea Bogdanovic; Mazul-Sunko, Branka; Pavicic, Anna Marija; Goranovic, Tanja; Maldini, Branka; Radocaj, Tomislav; Gavranovic, Zeljka; Mladic-Batinica, Inga; Sehovic, Mirna; Stourac, Petr; Harazim, Hana; Smekalova, Olga; Kosinova, Martina; Kolacek, Tomas; Hudacek, Kamil; Drab, Michal; Brujevic, Jan; Vitkova, Katerina; Jirmanova, Katerina; Volfova, Ivana; Dzurnakova, Paula; Liskova, Katarina; Dudas, Radovan; Filipsky, Radek; El Kafrawy, Samir; Abdelwahab, Hisham Hosny; Metwally, Tarek; Abdel-Razek, Ahmed; El-Shaarawy, Ahmed Mostafa; Hasan, Wael Fathy; Ahmed, Ahmed Gouda; Yassin, Hany; Magdy, Mohamed; Abdelhady, Mahdy; Mahran, Mohamed; Herodes, Eiko; Kivik, Peeter; Oganjan, Juri; Aun, Annika; Sormus, Alar; Sarapuu, Kaili; Mall, Merilin; Karjagin, Juri; Futier, Emmanuel; Petit, Antoine; Gerard, Adeline; Marret, Emmanuel; Solier, Marc; Jaber, Samir; Prades, Albert; Krassler, Jens; Merzky, Simone; De Abreu, Marcel Gama; Uhlig, Christopher; Kiss, Thomas; Bundy, Anette; Bluth, Thomas; Gueldner, Andreas; Spieth, Peter; Scharffenberg, Martin; Thiem, Denny Tran; Koch, Thea; Treschan, Tanja; Schaefer, Maximilian; Bastin, Bea; Geib, Johann; Weiss, Martin; Kienbaum, Peter; Pannen, Benedikt; Gottschalk, Andre; Konrad, Mirja; Westerheide, Diana; Schwerdtfeger, Ben; Wrigge, Hermann; Simon, Philipp; Reske, Andreas; Nestler, Christian; Valsamidis, Dimitrios; Stroumpoulis, Konstantinos; Antholopoulos, Georgios; Andreou, Antonis; Karapanos, Dimitris; Theodoraki, Kassiani; Gkiokas, Georgios; Tasoulis, Marios-Konstantinos; Sidiropoulou, Tatiana; Zafeiropoulou, Foteini; Florou, Panagiota; Pandazi, Aggeliki; Tsaousi, Georgia; Nouris, Christos; Pourzitaki, Chryssa; Bystritski, Dmitri; Pizov, Reuven; Eden, Arieh; Pesce, Caterina Valeria; Campanile, Annamaria; Marrella, Antonella; Grasso, Salvatore; De Michele, Michele; Bona, Francesco; Giacoletto, Gianmarco; Sardo, Elena; Giancarlo, Luigi; Sottosanti, Vicari; Solca, Maurizio; Volta, Carlo Alberto; Spadaro, Savino; Verri, Marco; Ragazzi, Riccardo; Zoppellari, Roberto; Cinnella, Gilda; Raimondo, Pasquale; La Bella, Daniela; Mirabella, Lucia; D'Antini, Davide; Pelosi, Paolo; Molin, Alexandre; Brunetti, Iole; Gratarola, Angelo; Pellerano, Giulia; Sileo, Rosanna; Pezzatto, Stefano; Montagnani, Luca; Pasin, Laura; Landoni, Giovanni; Zangrillo, Alberto; Beretta, Luigi; Di Parma, Ambra Licia; Tarzia, Valentina; Dossi, Roberto; Sassone, Marta Eugenia; Sances, Daniele; Tredici, Stefano; Spano, Gianluca; Castellani, Gianluca; Delunas, Luigi; Peradze, Sopio; Venturino, Marco; Arpino, Ines; Sher, Sara; Tommasino, Concezione; Rapido, Francesca; Morelli, Paola; Vargas, Maria; Servillo, Giuseppe; Cortegiani, Andrea; Raineri, Santi Maurizio; Montalto, Francesca; Russotto, Vincenzo; Giarratano, Antonino; Baciarello, Marco; Generali, Michela; Cerati, Giorgia; Leykin, Yigal; Bressan, Filippo; Bartolini, Vittoria; Zamidei, Lucia; Brazzi, Luca; Liperi, Corrado; Sales, Gabriele; Pistidda, Laura; Severgnini, Paolo; Brugnoni, Elisa; Musella, Giuseppe; Bacuzzi, Alessandro; Muhardri, Dalip; Gecaj-Gashi, Agreta; Sada, Fatos; Bytyqi, Adem; Karbonskiene, Aurika; Aukstakalniene, Ruta; Teberaite, Zivile; Salciute, Erika; Tikuisis, Renatas; Miliauskas, Povilas; Jurate, Sipylaite; Kontrimaviciute, Egle; Tomkute, Gabija; Xuereb, John; Bezzina, Maureen; Borg, Francis Joseph; Hemmes, Sabrine; Schultz, Marcus; Hollmann, Markus; Wiersma, Irene; Binnekade, Jan; Bos, Lieuwe; Boer, Christa; Duvekot, Anne; Veld, Bas In 'T; Werger, Alice; Dennesen, Paul; Severijns, Charlotte; De Jong, Jasper; Hering, Jens; Van Beek, Rienk; Ivars, Stefan; Jammer, Ib; Breidablik, Alena; Hodt, Katharina Skirstad; Fjellanger, Frode; Avalos, Manuel Vico; Mellin-Olsen, Jannicke; Andersson, Elisabeth; Shafi-Kabiri, Amir; Molina, Ruby; Wutai, Stanley; Morais, Erick; Tareco, Glória; Ferreira, Daniel; Amaral, Joana; De Lurdes Goncalves Castro, Maria; Cadilha, Susana; Appleton, Sofia; Parente, Suzana; Correia, Mariana; Martins, Diogo; Monteirosa, Angela; Ricardo, Ana; Rodrigues, Sara; Horhota, Lucian; Grintescu, Ioana Marina; Mirea, Liliana; Grintescu, Ioana Cristina; Corneci, Dan; Negoita, Silvius; Dutu, Madalina; Garotescu, Ioana Popescu; Filipescu, Daniela; Prodan, Alexandru Bogdan; Droc, Gabriela; Fota, Ruxandra; Popescu, Mihai; Tomescu, Dana; Petcu, Ana Maria; Tudoroiu, Marian Irinel; Moise, Alida; Guran, Catalin-Traian; Gherghina, Iorel; Costea, Dan; Cindea, Iulia; Copotoiu, Sanda-Maria; Copotoiu, Ruxandra; Barsan, Victoria; Tolcser, Zsolt; Riciu, Magda; Moldovan, Septimiu Gheorghe; Veres, Mihaly; Gritsan, Alexey; Kapkan, Tatyana; Gritsan, Galina; Korolkov, Oleg; Kulikov, Alexander; Lubnin, Andrey; Ovezov, Alexey; Prokoshev, Pavel; Lugovoy, Alexander; Anipchenko, Natalia; Babayants, Andrey; Komissarova, Irina; Zalina, Karginova; Likhvantsev, Valery; Fedorov, Sergei; Lazukic, Aleksandra; Pejakovic, Jasmina; Mihajlovic, Dunja; Kusnierikova, Zuzana; Zelinkova, Maria; Bruncakova, Katarina; Polakovicova, Lenka; Sobona, Villiam; Novak-Supe, Barbka; Pekle-Golez, Ana; Jovanov, Miroljub; Strazisar, Branka; Markovic-Bozic, Jasmina; Novak-Jankovic, Vesna; Voje, Minca; Grynyuk, Andriy; Kostadinov, Ivan; Spindler-Vesel, Alenka; Moral, Victoria; Unzueta, Mari Carmen; Puigbo, Carlos; Fava, Josep; Canet, Jaume; Moret, Enrique; Nunez, Mónica Rodriguez; Sendra, Mar; Brunelli, Andrea; Rodenas, Frederic; Monedero, Pablo; Martinez, Francisco Hidalgo; Temino, Maria Jose Yepes; Simon, Antonio Martínez; De Abajo Larriba, Ana; Lisi, Alberto; Perez, Gisela; Martinez, Raquel; Granell, Manuel; Vivo, Jose Tatay; Ruiz, Cristina Saiz; Ibañez, Jose Antonio De Andrés; Pastor, Ernesto; Soro, Marina; Ferrando, Carlos; Defez, Mario; Alvares-Santullano, Cesar Aldecoa; Perez, Rocio; Rico, Jesus; Jawad, Monir; Saeed, Yousif; Gillberg, Lars; Bengisun, Zuleyha Kazak; Kazbek, Baturay Kansu; Coskunfirat, Nesil; Boztug, Neval; Sanli, Suat; Yilmaz, Murat; Hadimioglu, Necmiye; Senturk, Nuzhet Mert; Camci, Emre; Kucukgoncu, Semra; Sungur, Zerrin; Sivrikoz, Nukhet; Ozgen, Serpil Ustalar; Toraman, Fevzi; Selvi, Onur; Senturk, Ozgur; Yildiz, Mine; Kuvaki, Bahar; Gunenc, Ferim; Kucukguclu, Semih; Ozbilgin, Şule; Maral, Jale; Canli, Seyda; Arun, Oguzhan; Saltali, Ali; Aydogan, Eyup; Akgun, Fatma Nur; Sanlikarip, Ceren; Karaman, Fatma Mine; Mazur, Andriy; Vorotyntsev, Sergiy; Rousseau, Guy; Barrett, Colin; Stancombe, Lucia; Shelley, Ben; Scholes, Helen; Limb, James; Rafi, Amir; Wayman, Lisa; Deane, Jill; Rogerson, David; Williams, John; Yates, Susan; Rogers, Elaine; Pulletz, Mark; Moreton, Sarah; Jones, Stephanie; Venkatesh, Suresh; Burton, Maudrian; Brown, Lucy; Goodall, Cait; Rucklidge, Matthew; Fuller, Debbie; Nadolski, Maria; Kusre, Sandeep; Lundberg, Michael; Everett, Lynn; Nutt, Helen; Zuleika, Maka; Carvalho, Peter; Clements, Deborah; Creagh-Brown, Ben; Watt, Philip; Raymode, Parizade; Pearse, Rupert; Mohr, Otto; Raj, Ashok; Creary, Thais; Chishti, Ahmed; Bell, Andrea; Higham, Charley; Cain, Alistair; Gibb, Sarah; Mowat, Stephen; Franklin, Danielle; West, Claire; Minto, Gary; Boyd, Nicholas; Mills, Gary; Calton, Emily; Walker, Rachel; Mackenzie, Felicity; Ellison, Branwen; Roberts, Helen; Chikungwa, Moses; Jackson, Clare; Donovan, Andrew; Foot, Jayne; Homan, Elizabeth; Montgomery, Jane; Portch, David; Mercer, Pauline; Palmer, Janet; Paddle, Jonathan; Fouracres, Anna; Datson, Amanda; Andrew, Alyson; Welch, Leanne; Rose, Alastair; Varma, Sandeep; Simeson, Karen; Rambhatla, Mrutyunjaya; Susarla, Jaysimha; Marri, Sudhakar; Kodaganallur, Krishnan; Das, Ashok; Algarsamy, Shivarajan; Colley, Julie; Davies, Simon; Szewczyk, Margaret; Smith, Thomas; Fernandez-Bustamante, Ana; Luzier, Elizabeth; Almagro, Angela; Melo, Marcos Vidal; Fernando, Luiz; Sulemanji, Demet; Sprung, Juraj; Weingarten, Toby; Kor, Daryl; Scavonetto, Federica; Tze, Yeo. - In: JOURNAL OF CLINICAL ANESTHESIA. - ISSN 0952-8180. - 104:(2025). [10.1016/j.jclinane.2025.111856]
Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries
Pistidda, LauraMembro del Collaboration Group
;
2025-01-01
Abstract
Introduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. Conclusion: The occurrence of PPCs in smokers is not different from non–smokers. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). Prior presentation: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
