title: Risk of perioperative respiratory complications and postoperative morbidity in a cohort of adults exposed to passive smoking.
abstract: OBJECTIVE
  To evaluate the risks of perioperative respiratory complications and postoperative morbidity associated with active and passive cigarette smoking.
  
  
  BACKGROUND
  Environmental tobacco smoke is associated with perioperative respiratory events in children, but its effect in adults is unknown.
  
  
  METHODS
  We conducted a cohort study of 736 adult patients receiving general anesthesia for major elective surgery. Patients were classified according to their self-reported smoking history and urinary cotinine concentration within 48 hours before surgery. The main outcomes were composite measures of perioperative respiratory complications and postoperative morbidity on the third day after surgery.
  
  
  RESULTS
  There were 313 (42.5%) never-smokers (reference group), 92 (12.5%) passive nonsmokers, 157 (21.3%) ex-smokers without environmental tobacco smoke exposure, 53 (7.2%) passive ex-smokers, and 121 (16.4%) smokers. The incidence of perioperative respiratory complications and postoperative morbidity was 9.5% [95% confidence interval (CI), 7.5-11.8] and 29.2% (95% CI, 26.0-32.6), respectively. Smoking was significantly associated with an increased risk of perioperative respiratory complications [relative risk (RR), 4.40; 95% CI, 2.20-8.80] and postoperative morbidity (RR, 1.86; 95% CI, 1.22-2.83). Although passive smoking was not associated with the risk of perioperative respiratory complications, the risk of postoperative morbidity was increased in passive nonsmokers (RR, 1.51; 95% CI, 1.04-2.21) and passive ex-smokers (RR, 2.21; 95% CI, 1.39-3.50).
  
  
  CONCLUSIONS
  One in 5 adults was exposed to environmental tobacco smoke before surgery. Passive cigarette smoking showed very little, if any, increased risk of perioperative respiratory complications. Both active exposure and passive exposure to cigarette smoke increased the risk of postoperative morbidity.
authors: From the Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors: Anna
authors: A
authors: Lee
authors: Po Tong
authors: PT
authors: Chui
authors: Chun Hung
authors: CH
authors: Chiu
authors: Perpetua E
authors: PE
authors: Tan
authors: Tsui Ping
authors: TP
authors: Tam
authors: Winnie
authors: W
authors: Samy
authors: Patricia Wy
authors: PW
authors: Tong
authors: Lester A H
authors: LA
authors: Critchley
authors: Tony
authors: T
authors: Gin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D057566:Self Report; D012907:Smoking / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution