THE BENEFIT OF VATS ON THE IMPACT OF SMOKING AND RECENT CESSATION ON 30-DAY OUTCOMES IN LOBECTOMY FOR CANCER IN VETERANS

Abstract

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Recent research has shown that smoking cessation as soon as two weeks prior to lobectomy for lung cancer results in lower odds of pulmonary complications relative to active smoking at the time of surgery. The increasing use of video-assisted thoracoscopic surgery (VATS) has reduced postoperative complications, but the effect of VATS on active smokers and recent quitters has not been investigated. The purpose of this study was to determine whether the use of VATS mitigates the negative effects of tobacco use on 30-day postoperative outcomes. METHODS: Patients who underwent VATS lobectomy for lung cancer at Veterans Health Administration (VHA) centers from 2012-2018 were retrospectively identified in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. The sample was stratified into 3 groups: smokers within 2 weeks of surgery (“active smokers”), those who quit between 2 weeks to 3 months prior to surgery (“recent quitters”), and those who had not smoked in 1 year or longer (“non-smokers”). Multivariable analysis was used to compare groups after adjusting for covariates. RESULTS: Of 2,814 patients who met inclusion criteria, 1,351 were non-smokers, 395 were recent quitters, and 1,068 were active smokers. Compared to recent quitters, active smokers were significantly more likely to be reintubated (adjusted odds ratio (aOR) of 2.53, 95% confidence interval (CI) 1.05 – 6.06, p=0.04); however, there was no difference when pulmonary composite (including prolonged intubation, pneumonia, and reintubation) and complication rates of other organ systems were compared. Compared to non-smokers, active smokers were more likely to suffer pulmonary complications (aOR=1.58, CI 1.12 – 2.23, p=0.01), overall complications (aOR=1.43, CI 1.06 – 1.92, p=0.02), renal complications (aOR=3.91, CI 1.10 – 13.98, p=0.04) and infectious complications (aOR=2.07, CI 1.12 – 3.83, p=0.02). There were no differences in morbidity between recent quitters and non-smokers. CONCLUSIONS: In spite of previous evidence that smoking cessation has a significant impact on pulmonary complications after lung resection, this analysis demonstrates that the use of VATS technique appears to mitigate the difference in risk of morbidity between patients who are active smokers at the time of surgery compared to recent quitters. This distinction may be the result of the established benefits of minimally invasive techniques for lobectomy. Despite the demonstrated advantages of VATS, the likelihood of suffering from complications – both pulmonary and otherwise – is still significantly higher in active smokers compared to non-smokers. CLINICAL IMPLICATIONS: In addition to the other recognized benefits of VATS for lobectomy in lung cancer, this approach may lessen the adverse effects of smoking on postoperative outcomes. Despite improved operative techniques, smoking cessation is still imperative in reducing pulmonary complications. DISCLOSURES: No relevant relationships by Jared Antevil, source=Web Response No relevant relationships by Michael Napolitano, source=Web Response No relevant relationships by Ethan Rosenfeld, source=Web Response No relevant relationships by Andrew Sparks, source=Web Response No relevant relationships by Gregory Trachiotis, source=Web Response