Effect of smoking on intraoperative sputum and postoperative pulmonary complication in minor surgical patients

Abstract

The effect of smoking for postoperative pulmonary complications (PPCs) in minor surgical patients who have an early recovery has not been evaluated. Smoking may also affect intraoperative sputum volume. We thus evaluated whether smoking had a relation to intraoperative sputum volume or PPCs in minor surgical patients. Smoking status was determined through the interviewer-assisted questionnaires. Intraoperative sputum volume was judged using the number of trials to suck up sputum from the trachea. Current and Ex-smokers were significantly more likely to have an increased intraoperative sputum volume when compared with Non-smokers (18.3% and 17.9% vs. 9.4%) although the relationship between smoking and PPCs was not demonstrated. In the multivariate models, Current and Ex-Smokers was identified as an independent risk factor of an increased intraoperative sputum volume (odds ratio, 2.7; 95% confidence interval, 1.6-4.6). The patients with < 2 months smoking cessation were more likely to have an increased intraoperative sputum volume. In conclusion, smoking is the risk factor of an increased intraoperative sputum volume, and preoperative smoking cessation > or = 2 months is recommended to reduce the risk of an increased intraoperative sputum volume, although the relationship between smoking and PPCs was not elucidated in minor surgical patients.

Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

“…1). There were seven prospective cohort studies, 12,[20][21][22][23][24][25] 16 retrospective cohort studies, [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and two RCTs (Table 1). 42,43 Both RCTs offered nicotine replacement therapy.…”

“…42,43 Both RCTs offered nicotine replacement therapy. 42,43 There were 14 studies from North America, 12,21,23,26,[30][31][32][33][34][35]37,[39][40][41] six from Europe, 22,27,28,38,42,43 four from Asia, 20,25,29,36 and one from Australia. 24 There were more male than female smokers, and smokers were younger than non-smokers or ex-smokers in many of the studies.…”

“…42,43 Respiratory complications Fifteen studies involving 19,323 patients reported respiratory complications (Table 2, available as electronic supplemental material [ESM]). 12,20,21,[23][24][25][26][27][28][29][30][31][32]40,42 There were four different time points commonly reported by the studies for respiratory complications, i.e., less than two weeks, two to four weeks, more than four weeks, and more than eight weeks of smoking cessation before surgery. Fourteen studies involving 17,160 patients were included in the metaanalyses.…”

“…12,20,21,[23][24][25][26][28][29][30][31][32]40,42 Eight of these studies involving 3,331 patients were prospective. 12,20,21,[23][24][25]42,43 As there was only one study examining the effect of less than or more than 12 weeks cessation, we could not perform a meta-analysis of this time point. 27 Summary of meta-analyses of respiratory complications The relative risk (RR) of postoperative respiratory complications was higher in those who continued smoking at the time of surgery compared with non-smokers (RR 2.11; 95% CI 1.51 to 2.94; I 2 = 61%; P \ 0.0001).…”

The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations

“…This unadjusted observation fits with previous studies and may be consistent with the hypothesis of improved ciliary function leading to increased sputum production, clearance and symptoms. [28][29][30][31] However, there is also the possibility of an indication bias leading to this finding in that individuals who have smoked for long periods of time often have some factors predisposing to future exacerbations, such as increasing dyspnea or prior exacerbations. Previous COPD exacerbation is a strong predictor of future exacerbations and may account for some of the unadjusted findings.…”