Preoperative Smoking Status Research Articles

Preoperative Assessment of Respiratory Function in Severely Obese Patients Undergoing Biliopancreatic Diversion

Since severe obesity is often associated with a pulmonary function defect and abdominal surgery increases the risks of respiratory postoperative complications (RPC), an increased incidence of RPC might occur after bariatric operations. A cohort of 146 severely obese patients undergoing biliopancreatic diversion (BPD) was retrospectively evaluated for the occurrence of RPC. Respiratory function was evaluated prior to BPD from the quotient between measured and predicted values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁) and the Tiffeneau index (TI: FEV₁/FVC). In this cohort of obese individuals the BMI degree prior to the operation was totally unrelated to the standardized values of TI and to the presence of restrictive or obstructive pulmonary disease. Globally, a very low rate of RPC (7.5%) was found; in patients with suspected restrictive pulmonary impairment, a high occurrence of RPC was observed (p < 0.05). When data are controlled for preoperative BMI values, smoking status and presence of sleep apnoea, a logistic regression model indicates that respiratory function data cannot predict the occurrence of RPC after bariatric surgery.

Current smoking predicts increased operative mortality and morbidity after cardiac surgery in the elderly☆

The effect of preoperative smoking status on the outcome of cardiac surgery remains unclear. Preoperative cessation may be associated with reduced postoperative pulmonary complications and in older patients preoperative smoking status appears to have a greater impact on outcome. This study was designed to assess the relationship between age, preoperative smoking status and outcomes from cardiac surgery. We performed a single-centre, retrospective cohort study to compare in-patient cardiac surgical mortality and morbidity in current smokers and never-smokers. We analysed the cardiac surgical population in its entirety and in age-stratified subsets using univariate and logistic regression analyses. During a five-year period ending March 2007, 10.8% of all patients (n=554) undergoing cardiac surgery were current smokers. Five hundred and fifty-four never-smokers undergoing cardiac surgery during the same period were identified. Overall, the smokers had a tendency towards higher in-patient mortality (4.3 vs. 2.3%, P=0.067) and increased rates of morbidity. Amongst over 70-year-olds, the current smokers had significantly higher rates of pulmonary complications (24.7 vs. 8.2%, P<0.0002), new renal replacement therapy (17.3 vs. 3.1%, P<0.0001) and infections (44.4 vs. 23.8%, P<0.0007). They had longer intensive care stay (6.2 vs. 2.8 days, P=0.002) with more intensive care unit readmissions (19.8 vs. 5.2%, P<0.0002) and significantly increased in-patient mortality (14.8 vs. 2.1%, P<0.0001). In the elderly smokers, mortality was significantly associated with the rate of pulmonary complications (P=0.03). Preoperative smoking status remained a predictor of pulmonary complications after logistic regression. The current data strengthen the observation that preoperative smoking status is predictive of adverse outcomes of cardiac surgery in the elderly. Further study into the effect of preoperative smoking cessation in the elderly may inform cessation counselling and the timing of surgery.

Prognostic value of a biologic classification of non-small-cell lung cancer into the growth patterns along with other clinical, pathological and immunohistochemical factors☆

Classification of non-small-cell lung cancer (NSCLC) into growth patterns is based on the following question: What does the tumour do with normal lung parenchyma? There are only three possible ways according to which a tumour can behave: (1) preservation of lung tissue and use of its microenvironment for further growth, (2) destruction of lung tissue and formation of new microenvironment for continued expansion and (3) preservation of lung tissue and formation of new microenvironment (modulation). The aim of the current study is to test the prognostic value of growth-pattern classification along with other clinical, pathological and immunohistochemical factors. Clinicopathological factors of 239 patients operated for NSCLC were retrospectively reviewed. Preoperative smoking status was determined based on two prospectively independent questionnaires. Co-morbidity was determined based on Charlson co-morbidity index (CCI). Haematoxylin-eosin tissue sections were analysed for the determination of tumour growth patterns, histological types, grading, necrosis and desmoplasia. Tumour cell proliferation, endothelial cell proliferation and microvessel density were determined based on double immunostaining with CD34 and Ki67 antibodies. Follow-up data were updated in 2008. According to the growth-pattern classification, 161 patients (67.4%) had a destructive, 33 (13.8%) a papillary and 45 (18.8%) an alveolar growth pattern. Multiple Cox regression analysis showed that older age (p<0.001), lymph node metastasis (p<0.001), growth-pattern classification (p=0.036) and current smokers (p=0.027) were independent prognostic factors for overall survival. Similar results were obtained for disease-specific and disease-free survival. Papillary (hazard ratio=1.658 and confidence interval=1.001-2.748, p=0.050) and alveolar (hazard ratio=2.056 and confidence interval=1.305-3.237, p=0.002) growth patterns were independent predictors of early recurrence. Growth-pattern classification remains a significant prognostic factor in NSCLC providing a possible explanation for survival differences in the same disease stage.

Impact of preoperative smoking status on postoperative complication rates and pulmonary function test results 1-year following pulmonary resection for non-small cell lung cancer

There is a lack of evidence in the literature regarding the impact of preoperative smoking status on pulmonary function test (PFT) results 1 year after resection for non-small cell lung cancer (NSCLC). Furthermore, there is disagreement in the literature regarding the impact of preoperative smoking cessation on postoperative complication rates. We performed a single-institution retrospective review of all NSCLC patients who underwent resection from April 2000 through April 2006. Timing of smoking cessation was stratified as follows: smoking cessation more than a month before surgery (Distant Smokers), smoking cessation within a month before surgery (Recent Smokers), and failure to achieve smoking cessation before surgery (Current Smokers). During the study period, 213 patients underwent NSCLC resection, 121 of whom (all males; mean age, 67.4 years) completed pre- and postoperative PFTs. After adjusting for potential confounding covariates (age, type of resection, and use of radiation therapy), we noted no significant difference ( p > 0.40) between groups after resection with regard to either relative (−12.20 ± 15.77 L [Distant Smokers], −15.38 ± 19.38 L [Recent Smokers], −9.61 ± 15.54 L [Current Smokers]) or absolute changes in percent predicted forced expiratory volume in 1 s (−0.14 ± 0.20 L [Distant Smokers], −0.18 ± 0.19 L [Recent Smokers], −0.12 ± 0.20 L [Current Smokers]). Because 92 patients did not complete postoperative PFTs, we performed a stratified analysis to assess for selection bias; as compared with those who completed PFTs, baseline PFT results did not significantly differ. We found no significant differences between the 3 groups with regard the overall rate of postoperative complications or the rate of any specific postoperative complication. In conclusion, smoking cessation immediately before NSCLC resection does not significantly impact postoperative pulmonary complication rates or 1-year postoperative PFT results and therefore should not be a reason to delay surgical resection.

The Natural History of Stenoses within Lower Limb Arterial Bypass Grafts Using a Graft Surveillance Program

Graft surveillance aims to identify those grafts that are at risk of failure as intervention in a patent but failing graft results in improved long-term patency and limb salvage rates compared to rescue of an occluded graft. Controversy exists as to which types of graft benefit the most from surveillance and whether patient factors such as diabetes and smoking status have an effect on graft survival. Our aims were (1) to clarify the natural history of midterm graft failure as a consequence of myointimal hyperplasia and (2) to identify which patients and grafts are at a higher risk of failure and at what time points this is most prevalent. Serial vascular laboratory and clinical data of 212 infrainguinal lower limb grafts in 197 patients were analyzed. Follow-up within the surveillance program was by focused examination with color flow duplex ultrasound at 0, 1, 3, 6, 12, and 18 months with respect to surgery. Outcomes were correlated with retrospectively collected data regarding patient demographics, smoking status, concurrent medication, comorbidity, and operative factors such as distal target vessel and conduit. During the program, 21.6% of grafts occluded. Overall, 16% of grafts underwent a salvage procedure, 40.5% of which were carried out at the 6-month time point. There were 56.6% of occlusions preceded by a stenotic lesion. Primary occlusions accounted for 95.9% in the prosthetic group and 66.5% in the femorocrural group. As a group, vein grafts were more likely to develop a progressive stenosis prior to occlusion, with 58.3% in this group predated by a stenotic lesion. Fewer than 75% of stenoses were common and had a variable natural history, with over 40% resolving or failing to progress. Throughout the study period, 56.2% of grafts remained stenosis-free. Stenoses were more common at the proximal anastomosis in the vein graft cohort. There were low rates of significant stenoses within the prosthetic group. These lesions were more likely to occur at the distal anastomosis but were poor predictors of occlusion. Statin use postoperatively was protective against the development of significant stenosis and occlusions, particularly in the above-knee grafts (p = 0.03). Surprisingly, preoperative smoking status was predictive of neither occlusion nor development of significant stenosis. The presence of diabetes was not predictive of poor outcome. Our findings suggest that graft surveillance is a valid method for detecting the presence of significant stenoses in vein grafts at high risk of failure without intervention. Despite the intensive follow-up, the program failed to detect lesions prior to occlusion in a large percentage of prosthetic and femorocrural grafts, so perhaps this group is poorly served by graft surveillance.

Haemoglobin, smoking and peripheral vascular disease.

One hundred and four patients with peripheral vascular disease requiring operation were reviewed retrospectively with respect to age, sex, preoperative haemoglobin, smoking habits and diabetic status. The preoperative haemoglobin levels and smoking status in 63 non-diabetic male patients with peripheral vascular disease were compared with a matched group of individuals treated for inguinal hernia. For all patients there was a significant correlation between smoking habits, preoperative haemoglobin level and the presence of peripheral vascular disease. The mechanisms by which smoking may damage the vascular tree are reviewed.