title: Adverse effects of smoking on postoperative outcomes in cancer patients.
abstract: BACKGROUND
  The possible negative effects of smoking on postoperative outcomes have not been well studied in cancer patients.
  
  
  METHODS
  We used the VA Surgical Quality Improvement Program (VASQIP) database for the years 2002-2008, which assesses preoperative risk factors and postoperative outcomes for patients undergoing major surgery within the VA healthcare system.
  
  
  RESULTS
  Compared with never smokers, prior smokers and current smokers with GI malignancies were significantly more likely to have surgical site infection (SSI) (odds ratio [OR], 1.25; 95% confidence interval [95% CI], 1.09-1.44) (OR, 1.20; 95% CI, 1.05-1.38), combined pulmonary complications (combined pulmonary outcome [CPO]: pneumonia, failure to wean from ventilator, reintubation) (OR, 1.60; 95% CI, 1.38-1.87) (OR, 1.96; 95% CI, 1.68-2.29), and return to the operating room (OR, 1.20; 95% CI, 1.03-1.39) (OR, 1.31; 95% CI, 1.13-1.53), respectively. Both prior and current smokers had a significantly higher mortality at 30 days (OR, 1.50; 95% CI, 1.19-1.89) (OR, 1.41; 95% CI, 1.08-1.82) and 1 year (OR, 1.22; 95% CI, 1.08-1.38) (OR, 1.62; 95% CI, 1.43-1.85). Thoracic surgery patients who were current smokers were more likely to develop CPO (OR, 1.62; 95% CI, 1.25-2.11) and mortality within 1 year (OR, 1.50; 95% CI, 1.17-1.92) compared with nonsmokers, but SSI rates were not affected by smoking status. Current smokers had a significant increase in postsurgical length of stay (overall 4.3% [P < .001], GI 4.7% [P = .003], thoracic 9.0% [P < .001]) compared with prior smokers.
  
  
  CONCLUSIONS
  Prior and current smoking status is a significant risk factor for major postoperative complications and mortality following GI cancer and thoracic operations in veterans. Smoking cessation should be encouraged prior to all major cancer surgery in the VA population to decrease postoperative complications and length of stay.
authors: Department of Surgery, University of Colorado at Denver, Denver, CO, USA. Csaba.Gajdos@ucdenver.edu
authors: Csaba
authors: C
authors: Gajdos
authors: Mary T
authors: MT
authors: Hawn
authors: Elizabeth J
authors: EJ
authors: Campagna
authors: William G
authors: WG
authors: Henderson
authors: Jasvinder A
authors: JA
authors: Singh
authors: Thomas
authors: T
authors: Houston
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D016540:Smoking Cessation; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate; D014570:Urologic Diseases / Q000453:epidemiology