Everybody knows that smokin’ ain’t allowed (in school) before lung surgery!

Abstract

In the 1973 classic ‘Smokin’ in the Boys Room’, the Brownsville Station’s singer refrain is—‘don’t want the teacher to fill me up with your rules, but everybody knows that smokin’ ain’t allowed in school!’ [1] Similarly, the universal medical directive including pre-op lung cancer resection is ‘Stop Smoking’. Kadomatsu, Sugiyama and others in the article ‘Relationship of smoking cessation period with the incidence of complications in lung cancer surgery’ [2] re-evaluates the length of smoking cessation and pack-years of smoking on lung cancer resection morbidity and outcomes. The authors have shown in 911 patients undergoing lung cancer resection from 2014 to 2017 that pulmonary complications including pneumonia, prolonged air-leak and empyema and total complications are 5 times and 2 times higher respectively in smokers as compared to the non-smoker groups. The pre-op smoking cessation intervals included—9.6% patients in the current (<4 weeks) group, 17% patients in recent (4 weeks to 12 months) group, 13% in the distant (12 months to 5 years) group and 30% ex-smokers (>5 years) group. Using this classification, postoperative complications were greater in current versus recent groups but both were less than distant and ex-smoker cohorts. Interestingly, the ex-smoker group had fewer post-op complications than the distant group and the distant cohort had more complications than the current and recent smoking groups.