title: A prospective study of tobacco smoking as a predictor of complications in general surgery.
abstract: OBJECTIVE
  To analyze whether tobacco smoking is related to nosocomial infection, admission to the intensive care unit, in-hospital death, and length of stay.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  The Service of General Surgery of a tertiary-care hospital.
  
  
  METHODS
  A consecutive series of patients admitted for more than 1 day (N = 2,989).
  
  
  RESULTS
  Sixty-two (2.1%) patients died and 503 (16.8%) acquired a nosocomial infection, of which 378 (12.6%) were surgical site and 44 (1.5%) were lower respiratory tract. Smoking (mainly past smoking) was associated with a worse health status (eg, longer preoperative stay and higher American Society of Anesthesiologists score). A long history of smoking (> or = 51 pack-years) increased postoperative admission to the intensive care unit (adjusted odds ratio [OR] = 2.86; 95% confidence interval [CI95], 1.21 to 6.77) and in-hospital mortality (adjusted OR = 2.56; CI95, 1.10 to 5.97). There was no relationship between current smoking and surgical-site infection (adjusted OR = 0.99; CI95, 0.72 to 1.35), whereas a relationship was observed between past smoking and surgical-site infection (adjusted OR = 1.46; CI95, 1.02 to 2.09). Current smoking and, to a lesser degree, past smoking augmented the risk of lower respiratory tract infection (adjusted OR = 3.21; CI95, 1.21 to 8.51). Smokers did not undergo additional surgical procedures more frequently during hospitalization. In the multivariate analysis, length of stay was similar for smokers and nonsmokers.
  
  
  CONCLUSIONS
  Smoking increases in-hospital mortality, admission to the intensive care unit, and lower respiratory tract infection, but not surgical-site infection. Deleterious effects of smoking are also observed in past smokers and they cannot be counteracted by hospital cessation programs.
authors.affiliation: Division of Preventive Medicine and Public Health, University of Jain, Jain, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Delgado-Rodriguez
authors.forename: Marcelino
authors.initials: M
authors.lastname: Medina-Cuadros
authors.forename: Gabriel
authors.initials: G
authors.lastname: Martínez-Gallego
authors.forename: Antonio
authors.initials: A
authors.lastname: Gómez-Ortega
authors.forename: Marcial
authors.initials: M
authors.lastname: Mariscal-Ortiz
authors.forename: Silvia
authors.initials: S
authors.lastname: Palma-Pérez
authors.forename: María
authors.initials: M
authors.lastname: Sillero-Arenas
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*