title: Impact of smoking on perioperative outcomes after major surgery.
abstract: BACKGROUND
  To investigate the impact of smoking on perioperative outcomes in patients undergoing one of the 16 major cardiovascular, orthopedic, or oncologic surgical procedures.
  
  
  METHODS
  We relied on the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2011). Procedure-specific multivariable logistic regression models assessed the association between smoking status (non, former, or current smokers) and risk of 30-day morbidity and mortality.
  
  
  RESULTS
  Overall, 141,802 patients were identified. A total of 12.5%, 14.6%, and 14.9% of non, former, and current smokers, respectively, experienced at least one complication (P < .001). In multivariable models, current smokers had higher odds of overall, pulmonary, wound, and septic/shock complications following most cardiovascular and oncologic surgeries compared with nonsmokers. The odds of experiencing such adverse outcomes were significantly lower in former smokers compared with current smokers, but still higher compared with nonsmokers.
  
  
  CONCLUSIONS
  The effect of smoking on perioperative outcomes is procedure dependent. Current and, even though mitigated, former smoking negatively influence outcomes following cardiovascular or oncologic procedures. Patients undergoing major procedures should be encouraged to discontinue tobacco smoking to achieve optimal procedural outcomes.
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. Electronic address: dr.marianne.schmid@gmail.com.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Logan
authors.initials: L
authors.lastname: Campbell
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Kapoor
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Dane E
authors.initials: DE
authors.lastname: Klett
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D013504:Cardiovascular Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects*
keywords: Cardiovascular; Oncologic; Orthopedic; Perioperative outcomes; Smoking; Surgery