The effect of smoking on post-operative complications of selected surgical interventions and on their cost analyses

Abstract

This paper studies the effect of smoking on post-operative complications in certain surgical interventions in Czech hospitals. Patients were divided into three groups – smokers, ex-smokers and non-smokers. The first part was a retrospective study of cholecystectomies performed in Jihlava Hospital. The hospital provided anonymised data concerning 253 patients who were operated on in 2014, including 61 smokers, 15 ex-smokers and 177 non-smokers. Consequently, a prospective observational study of the effect of smoking on complications after planned hip or knee replacement surgeries was carried out. The study included all patients of the orthopaedic departments of the University Hospital Královské Vinohrady and the Regional Hospital Mladá Boleslav; those included were scheduled for planned surgeries in January or February 2017, and signed the informed consent for participation in the study. Data concerning a total of 61 patients, including 27 non-smokers, 25 ex-smokers and 9 smokers were collected. This study, the first of its kind in the Czech environment, found neither a higher percentage of complications after the studied surgical interventions in smokers, nor any positive effect of short-term smoking cessation on post-operative complications. Both the results of a literary review and expert opinions of surgeons vary. Above all, Scandinavian authors have defended the positive effect of a short-term smoking cessation before surgery. However, this position seems to be in a conflict with the results of our study, which found the highest incidence of post-operative complications in ex-smokers. The study indicates a need for a carefully designed and sufficiently large research focusing on ex-smokers and the impact of the pre-operative smoking cessation, which would yield statistically significant results (whether positive or negative).