title: Impact of smoking status on outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery.
abstract: BACKGROUND
  There is a paucity of data on the impact of smoking status on outcomes after concomitant aortic valve replacement and coronary artery bypass graft (AVR-CABG) surgery.
  
  
  METHODS
  Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who were nonsmokers, previous smokers, and current smokers using chi-square test and t-test. The independent impact of smoking status on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively.
  
  
  RESULTS
  Concomitant AVR-CABG surgery was performed in 2,563 patients; smoking status was recorded in 2,558 (99.8%) patients. Of these, 1,052 (41.1%) patients had no previous smoking history, 1,345 (52.6%) patients were previous smokers, and 161 (6.3%) patients were current smokers. The 30-day mortality rate was 3.5% in nonsmokers, 4.1% in previous smokers, and 3.1% in current smokers (p = nonsignificant). The incidence of perioperative complications was similar in the three groups. The mean follow-up period for this study was 36 months (range, 0-105 months). After adjusting for differences in patient variables, the incidence of late mortality was higher in previous smokers (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14-1.81; p = 0.002) compared with nonsmokers. A trend toward increased late mortality in current smokers was noted (HR, 1.34; 95% CI, 0.86-2.08; p = 0.201).
  
  
  CONCLUSIONS
  Smoking is not associated with adverse outcomes after concomitant AVR-CABG surgery. Smoking status should not, therefore, preclude these patients from undergoing this procedure. Given the adverse effect of smoking on overall cardiovascular morbidity and mortality and late postoperative mortality, patients should be encouraged to quit smoking.
authors.affiliation: Department of Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Shan
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Surgery (MMC), Monash University and Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
authors.affiliation: Cabrini Medical Centre, Malvern, Victoria, Australia.
authors.forename: Gilbert C
authors.initials: GC
authors.lastname: Shardey
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome