Association between smoking and postoperative delirium in surgical patients with pulmonary hypertension: a secondary analysis of a cohort study

Abstract

Background Previous studies have declared that smoking was a risk factor for postoperative delirium (POD), but others have inconsistent results. Up till now, the association between smoking and POD has not been verified. This study investigates the relationship between smoking and POD in patients with pulmonary hypertension (PHTN) in the United States. Methods Patients with PHTN who underwent non-cardiac, non-obstetric surgery were enrolled in the original research completed by Aalap C. et al. We further excluded the patients undergoing intracranial surgery and the patients with sepsis and perioperative stroke to avoid interference with POD assessment. The generalized linear model and generalized additive model were used to explore the relationship between smoking and POD. The propensity score adjustment was used for sensitivity analyses. Results Five hundred thirty-nine patients were included in this study. The overall incidence of POD was 3.0% (16/539). After adjusting the potential confounders (age, systemic hypertension, coronary artery disease, COPD, length of surgery, intrathoracic surgery, vascular surgery), a positive relationship was found between smoking status and POD (OR = 4.53, 95% CI: 1.22 to 16.86, P = 0.0243). In addition, the curvilinear relationship between smoking burden (pack-years) and POD is close to a linear relationship. Conclusion Smoking probably shows a positive correlation with POD in patients with PHTN.

Social vulnerability and surgery outcomes: a cross-sectional analysis

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Incidence and risk factors for postoperative delirium after head and neck cancer surgery: an updated meta-analysis

“…Interestingly, our results suggested that a history of smoking was considered as a significant predictor for POD after head and neck cancer surgery. Similar to our current study, Zhou et al also found that smoking was positively related to POD in patients undergoing non-cardiac and non-obstetric surgery [ 46 ], which was associated with the impaired cholinergic function due to nicotine withdrawal resulting from sudden cessation of smoking [ 47 ].…”

Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants

“…Although beyond the scope of the current meta-analysis, additional studies concerning the molecular epidemiology of POD are needed to understand the interaction between these patient individual factors and potential mechanisms. Moreover, the crucial mechanism for safe anesthesia management is to maintain the stability of blood pressure [ 71 ]. As a highly metabolic organ, the brain is very sensitive to ischemia and hypoxia.…”