title: Smoking cessation before coronary artery bypass grafting improves operative outcomes.
abstract: BACKGROUND
  The detrimental effect of active smoking on operative outcome after coronary artery bypass grafting (CABG) is still debated and smoking cessation programs are usually deferred until after surgery. The potential benefit from smoking cessation on postoperative outcomes is investigated in this study.
  
  
  METHODS
  A retrospective analysis on a large cohort of patients who underwent CABG at a single institution was performed. Generalized boosted regression modeling was used to estimate the multinominal propensity scores for smoking status categories and the average treatment effect on the treated was calculated for all outcomes of interest.
  
  
  RESULTS
  A total of 6113 patients who underwent isolated CABG for the first time were included. At baseline, there were 640 (10.4%) current smokers, 3309 (54.1%) ex-smokers, and 2164 (35.3%) nonsmokers. Multilevel propensity score weighted analysis showed a beneficial effect of smoking cessation compared with current smoking, which increased the risk for all major pulmonary complications (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.13-2.10; P = .006), including reintubation (OR, 1.95; 95% CI, 1.17-3.25; P = .01), full tracheostomy (OR, 3.04; 95% CI, 1.49-6.18; P = .002), lung infection/consolidation (OR, 1.44; 95% CI, 1.02-2.02; P = .03). Although smoking cessation did not significantly improve other outcomes, it was associated with a nonsignificant trend toward a decreased risk for in-hospital mortality (OR, 1.83; 95% CI, 0.85-3.91; P = .1).
  
  
  CONCLUSIONS
  This study showed that smoking cessation before CABG reduced the risk of serious pulmonary complications. The present findings indicate that embarking on a smoking cessation program should not be deferred until after surgery.
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom. Electronic address: umberto.benedetto@hotmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.
authors.forename: Hassan
authors.initials: H
authors.lastname: Kattach
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.
authors.forename: Danilo
authors.initials: D
authors.lastname: Ruggiero
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008131:London; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D016017:Odds Ratio; D057234:Preoperative Period; D057216:Propensity Score; 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