Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

Abstract

BackgroundTobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence review on its impact on intraoperative and postoperative outcomes.ObjectivesTo undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intraoperative and postoperative harm.Eligibility criteria participantsChildren aged 0–18 years undergoing anaesthetic or surgical procedures, any country, English language papers.ExposureETS exposure assessed via questioning, observation or biological marker.Outcome measuresFrequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes.Results28 relevant studies were identified; 15 considered anaesthetic outcomes, 12 surgical outcomes, and 1 a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of perianaesthetic respiratory adverse events (Pooled risk ratio 2.52 CI 95% 1.68 to 3.77), and some evidence that ear and sinus surgery outcomes were poorer for children exposed to ETS.ConclusionsETS exposure increases the risk of anaesthetic complications and some negative surgical outcomes in children, and this should be considered when planning surgery. Research is required to demonstrate whether changes in household smoking behaviour prior to surgery reduces risk of adverse outcomes, and to close the evidence gap around other outcomes such as wound healing and respiratory infections.Trial registration numberReview registration number 42014014557.

Development of a prediction model for postoperative complications after primary hypospadias correction

“…Although treatment-related factors were investigated most frequently, factors concerning the neonatal period, such as mode of delivery and breast feeding, and other patient-related factors, such as exposure to smoking in the first years of the child's life, may also play an important role. The effects of these factors on the child's general health or immune status [12][13][14] may influence the risk of postoperative complications. Some factors were studied in association with surgical complications before [12,14], but never for patients with hypospadias.…”

“…The effects of these factors on the child's general health or immune status [12][13][14] may influence the risk of postoperative complications. Some factors were studied in association with surgical complications before [12,14], but never for patients with hypospadias. The aim of this study was to develop and internally validate a prediction model using treatment-and patient-related factors to predict the risk of postoperative complications within one year after primary hypospadias correction.…”

Reducing pediatric exposure to environmental tobacco smoke: The effects of pediatric exposure to environmental tobacco smoke and the role of pediatric perioperative care

“…There is inconsistency in the evidence on the impact of exposure to ETS on ENT surgical outcomes, but exposure to ETS may decrease the effectiveness or duration of tympanostomy tubes. 4 Smoking in adult patients undergoing general anesthesia is known to increase anesthetic and surgical complications such as delayed wound healing and delayed discharge, and while these may be extrapolated to the pediatric population, there is no evidence in the literature to support this yet. Although smoking confers some protection against postoperative nausea and vomiting in adults, this has been shown to not be the case in children exposed to ETS, who had the same rates of PONV post adenotonsillectomy as children not exposed to ETS, as measured by both cotinine levels and questionnaire.…”

Malaysian adolescents’ exposure to secondhand smoke in the car of their parents/guardians: A nationwide cross-sectional school-based study

“…In addition, children may have a higher breathing rate. Children's exposure to SHS increases the risk of respiratory health diseases such as coughing, asthma, bronchitis, and pneumonia, which adversely affects their lung function 5 , increases the risk of anaesthetic complications and some negative surgical outcomes in children 6 . Furthermore, exposure to SHS may affect their cognitive development 7 .…”