Smoking Cessation Reduces Postoperative Complications: A Systematic Review and Meta-analysis

Mills, Edward J.; Eyawo, Oghenowede; Lockhart, Ian; Kelly, Steven; Wu, Ping; Ebbert, Jon O.

doi:10.1016/j.amjmed.2010.09.013

Cited by 467 publications

(273 citation statements)

References 49 publications

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“…It was found that the percentage of impaired wound healing was greater in nonsmokers than individuals who had not smoked for more than 22 days (47% nonsmokers versus 67%, p\0.05) after head and neck surgery [11]. A risk reduction of 19% is seen for each week of cessation before surgery [19]. However, former smokers were considered to have a lifetime greater risk of healing complications and SSI compared with nonsmokers [28].…”

Section: Discussionmentioning

confidence: 99%

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Claessen

Braun

Leeuwen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Surgical site infections are one of the more common major complications of elbow fracture surgery and can contribute to other adverse outcomes, prolonged hospital stays, and increased healthcare costs. Questions/purposes We asked: (1) What are the factors associated with a surgical site infection after elbow fracture surgery? (2) When taking the subset of closed elbow fractures only, what are the factors associated with a surgical site infection? (3) What are the common organisms isolated from an elbow infection after open treatment? Methods One thousand three hundred twenty adult patients underwent surgery for an elbow fracture between January 2002 and July 2014 and were included in our study. Forty-eight of 1320 patients (4%) had a surgical site infection develop. Thirty-four of 1113 patients with a closed fracture (3%) had a surgical site infection develop.Results For all elbow fractures, use of plate and screw fixation (adjusted odds ratio [OR]= 2.2; 95% CI, 1.0-4.5; p = 0.041) and use of external fixation before surgery (adjusted OR = 4.7; 95% CI, 1.1-21; p = 0.035) were associated with higher infection rates. When subset analysis was performed for closed fractures, only smoking (adjusted OR = 2.2; 95% CI, 1.1-4.5; p = 0.023) was associated with higher infection rates. Staphylococcus aureus was the most common bacteria cultured (59%). Conclusions The only modifiable risk factor for a surgical site infection after open reduction and internal fixation was cigarette smoking. Plate fixation and temporary external fixation are likely surrogates for more complex injuries, therefore no recommendations should be inferred from this association. Surgeons should counsel patients who smoke. Level of Evidence Level IV, prognostic study.

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Section: Discussionmentioning

confidence: 99%

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Claessen

Braun

Leeuwen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…6,7,17 Our review included more studies than a previous review which was limited to a comparison of smokers vs ex-smokers who quit less than eight weeks before surgery. 17 We also examined wound-healing complications, and we did not pool the results of studies with different periods of cessation.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Two systematic reviews showed that preoperative smoking cessation programs increased short-term (up to six months) abstinence. 8,9 Consequently, both the American Society of Anesthesiologists 10 and the Canadian Anesthesiologists' Society 11 recommend promoting smoking cessation before surgery.…”

Section: Constatations Principalesmentioning

confidence: 99%

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

Wong

Lam

Abrishami

et al. 2011

Can J Anesth/J Can Anesth

320

161

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Purpose The literature was reviewed to determine the risks or benefits of short-term (less than four weeks) smoking cessation on postoperative complications and to derive the minimum duration of preoperative abstinence from smoking required to reduce such complications in adult surgical patients. Source We searched MEDLINE, EMBASE, Cochrane, and other relevant databases for cohort studies and randomized controlled trials that reported postoperative complications (i.e., respiratory, cardiovascular, woundhealing) and mortality in patients who quit smoking within six months of surgery. Using a random effects model, meta-analyses were conducted to compare the relative risks of complications in ex-smokers with varying intervals of smoking cessation vs the risks in current smokers. Principal findings We included 25 studies. Compared with current smokers, the risk of respiratory complications was similar in smokers who quit less than two or two to four weeks before surgery (risk ratio [RR] 1.20; 95% confidence interval [CI] 0.96 to 1.50 vs RR 1.14; CI 0.90 to 1.45, respectively). Smokers who quit more than four and more than eight weeks before surgery had lower risks of respiratory complications than current smokers (RR 0.77; 95% CI 0.61 to 0.96 and RR 0.53; 95% CI 0.37 to 0.76, respectively). For wound-healing complications, the risk was less in smokers who quit more than three to four weeks before surgery than in current smokers (RR 0.69; 95% CI 0.56 to 0.84). Few studies reported cardiovascular complications and there were few deaths. Conclusion At least four weeks of abstinence from smoking reduces respiratory complications, and abstinence of at least three to four weeks reduces wound-healing complications. Short-term (less than four weeks) smoking cessation does not appear to increase or reduce the risk of postoperative respiratory complications.Author contributions Jean Wong was involved in data abstraction, interpretation of data, drafting and revising, and final approval of the article. David Paul Lam was involved in data abstraction and drafting of the article. Amir Abrishami was involved in drafting and revising the article, data analysis, and interpretation of the data. Matthew Chan revised and approved the final version of the article. Frances Chung was involved in the conception and design, revising, and final approval of the article. (RR: 0,77; IC a`95 %: 0,96 et RR: 0,53; IC a9 5 %: 0,76, respectivement). Concernant les complications lie´es a`la cicatrisation, le risque a e´te´plus faible chez les fumeurs ayant cesse´plus de trois a`quatre semaines avant l'intervention que chez les fumeurs actifs (RR: 0,69; IC a`95%: 0,56-0,84). Peu d'e´tudes ont de´crit des complications cardiovasculaires et il n'y a eu que peu de de´ce`s. Conclusion Un minimum de quatre semaines d'abstinence du tabagisme diminue le risque de complications respiratoires et un minimum de trois a`quatre semaines re´duit le risque de complications lie´es a`la cicatrisation. L'arreˆt à court terme (moins de quatre semaines) du tab...

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“…The relationship between cigarette smoking and postoperative complications is well established in the literature, such as infection of surgical wound (SW), graft necrosis or incisional hernias [2][3][4][5]20 . Soresen et al 21 reports that smoking is associated with SW infection at all types of surgery, with an odds ratio (OR) of 2,95 for SW infections in light smokers and an OR of 3,46 for heavy smokers.…”

Section: Discussionmentioning

confidence: 99%

“…There are many clinical trials and meta-analyses showing that smokers who underwent surgical events had more post operatory complications comparing to non smokers or smokers who had a bigger cessation time before and after surgery [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

The effects of passive tobacco smoking on the microcirculation of the abdominal wall in rats

et al. 2016

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Brazil. Scientific, intellectual, conception and design of the study; analysis and interpretation of data, critical revision, final approval. ABSTRACT PURPOSE:To analysis the effects of passive smoking on the microstructure of tissues of the abdominal wall regarding microcirculation, using histopathological study of the tobacco exposed rats. METHODS: Twenty four male Wistar rats were divided in Control Group (CG = 8 animals) and Exposition Groups (EG = 16 animals).EG was exposed to cigarette smoke 4x/day for 120 days, while CG was preserved from exposure. Food, water and housing were similar for both groups. After 120 days, urine samples were collected before necropsy to analyze cotinine levels (ng/mL) in urine and blinded histopathological analysis of the abdominal wall performed to count arteries and veins in dermal and muscular fascia layer. RESULTS:No difference in weight was observed between both groups (P>0.05). Cotinine concentration was significantly higher in EG (P<0.05). In dermal layer, the average of vessels per animal was 8.72 (IC95%: 8.31-9.13) for CG and 11, for EG. In muscular fascia layer the average of vessels per animal was ) for CG, whereas the average for EG was of 14,85 (IC95%: 12.71-17.01) (P<0.05). CONCLUSION:Exposition to passive smoking may cause increase in the number of vessels in dermal layer, with the opposite effects at the muscular fascia layer.

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Smoking Cessation Reduces Postoperative Complications: A Systematic Review and Meta-analysis

Cited by 467 publications

References 49 publications

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

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

The effects of passive tobacco smoking on the microcirculation of the abdominal wall in rats

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