title: Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis.
abstract: BACKGROUND
  Tobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence review on its impact on intraoperative and postoperative outcomes.
  
  
  OBJECTIVE
  To undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intraoperative and postoperative harm.
  Children aged 0-18 years undergoing anaesthetic or surgical procedures, any country, English language papers.
  
  
  METHODS
  ETS exposure assessed via questioning, observation or biological marker.
  
  
  METHODS
  Frequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes.
  
  
  RESULTS
  28 relevant studies were identified; 15 considered anaesthetic outcomes, 12 surgical outcomes, and 1 a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of perianaesthetic respiratory adverse events (Pooled risk ratio 2.52 CI 95% 1.68 to 3.77), and some evidence that ear and sinus surgery outcomes were poorer for children exposed to ETS.
  
  
  CONCLUSIONS
  ETS exposure increases the risk of anaesthetic complications and some negative surgical outcomes in children, and this should be considered when planning surgery. Research is required to demonstrate whether changes in household smoking behaviour prior to surgery reduces risk of adverse outcomes, and to close the evidence gap around other outcomes such as wound healing and respiratory infections.
  
  
  BACKGROUND
  Review registration number 42014014557.
authors.affiliation: Department of Public Health, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chiswell
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Akram
mesh_terms: D000293:Adolescent; D000777:Anesthetics / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D064887:Observational Studies as Topic; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000209:etiology; D016540:Smoking Cessation; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D000777:Anesthetics; D014028:Tobacco Smoke Pollution
keywords: Anaesthetics; Paediatric Surgery; Passive Smoking; Public Health; Tobacco Smoke