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Preoperative Smoking Status and Postoperative Complications: A Systematic Review and Meta-analysis

Grønkjær, Marie BSc*; Eliasen, Marie MSc*; Skov-Ettrup, Lise Skrubbeltrang MSc*; Tolstrup, Janne Schurmann PhD, DMSc*; Christiansen, Anne Hjøllund MSc*; Mikkelsen, Stine Schou MSc*; Becker, Ulrik MD, DMSc*,†; Flensborg-Madsen, Trine PhD*,‡

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182911913
Meta-Analyses
Abstract

Objective: To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.

Background: The conclusions of studies examining the association between preoperative smoking and postoperative complications are inconsistent, thus there is a need for a review and meta-analysis to summarize the existing evidence.

Methods: A systematic review and meta-analysis based on a search in MEDLINE, EMBASE, CINAHL, and PsycINFO. Included were original studies of the association between smoking status and postoperative complications occurring within 30 days of operation. In total, 9354 studies were identified and reviewed for eligibility and data were extracted. Forest plots and summarized relative risks (RR) including 95% confidence intervals (CIs) were estimated for various complication types.

Results: Of the 9354 identified studies, 107 studies were included in the meta-analyses and based on these, 157 data sets were extracted. Preoperative smoking was associated with an increased risk of various postoperative complications including general morbidity (RR = 1.52, 95% CI: 1.33–1.74), wound complications (RR = 2.15, 95% CI: 1.87–2.49), general infections (RR = 1.54, 95% CI: 1.32–1.79), pulmonary complications (RR = 1.73, 95% CI: 1.35–2.23), neurological complications (RR = 1.38, 95% CI: 1.01–1.88), and admission to intensive care unit (RR = 1.60, 95% CI: 1.14–2.25). Preoperative smoking status was not observed to be associated with postoperative mortality, cardiovascular complications, bleedings, anastomotic leakage, or allograft rejection.

Conclusions: Preoperative smoking was found to be associated with an increased risk of the following postoperative complications: general morbidity, wound complications, general infections, pulmonary complications, neurological complications, and admission to the intensive care unit.

In Brief

In this meta-analysis, we systematically summarized the current evidence of the association between preoperative smoking and postoperative complications elaborated on complication type. We found an increased risk of several postoperative complications among patients smoking preoperatively, which implies that a special focus should be to reduce preoperative smoking among surgical patients.

Author Information

*National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

Department of Medical Gastroenterology, Hvidovre Hospital, Copenhagen University Hospital, Denmark; and

Unit of Medical Psychology, Department of Public Health, University of Copenhagen, Denmark

Reprints: Trine Flensborg-Madsen, PhD, Unit of Medical Psychology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 15, 1353 Copenhagen K, Denmark. E-mail: tfma@sund.ku.dk.

Disclosure: The authors have no conflicts of interest to declare.

The Danish Health and Medicines Authority and the National Institute of Public Health, University of Southern Denmark funded this work. The Danish Health and Medicines Authority attributed to the development of the search strategy and with feedback in the preliminary phase but had no additional role in the design, conduct, or reporting of the review and meta-analysis, neither did the National Institute of Public Health, University of Denmark.

© 2014 by Lippincott Williams & Wilkins.