Preoperative Smoking Cessation Period Is Not Related to Postoperative Respiratory Complications in Patients Undergoing Lung Cancer Surgery

Smoking Status and Outcomes following Lung Resection

BACKGROUND

 Surgical resection is the gold standard treatment for the management of early-stage lung cancer. Several modifiable factors may significantly influence postoperative morbidity and mortality. We examined the outcomes of patients following lung resection based upon preoperative smoking status to quantify the impact on postoperative outcomes.

METHODS

 Data from consecutive lung resections from January 1, 2012 to June 11, 2021 were included. Biopsies for interstitial lung disease and resections for emphysematous lung or bullae were excluded. Patients were divided into three cohorts: current smokers (those who smoked within 4 weeks of surgery), ex-smokers (those who stopped smoking prior to 4 weeks leading up to surgery), and nonsmokers (those who have never smoked). Patient's preoperative variables, postoperative complications, length of stay, and mortality were examined.

RESULTS

 A total of 2,426 patients were included in the study. A total of 502 patients (20.7%) were current smokers, 1,445 (59.6%) were ex-smokers and 479 patients (19.7%) nonsmokers. Of those smoking immediately prior to surgery 36.9% developed postoperative complications. Lower respiratory tract infections (18.1%) and prolonged air leak (17.1%), in particular, were significant higher in smokers. 90-day mortality (5.8%) was higher in the current smokers when compared with ex- and nonsmokers (5.3 and 1%, respectively). Median length of hospital stay, readmissions, and cost of hospital stay was also higher in the current smoker cohort.

CONCLUSION

 Smoking immediately prior to surgery is associated with an increase in morbidity, mortality, and length of stay. Not only does this have a significant individual impact, but it is also associated with a significant financial burden to the National Health Service.

Smoking cessation in Chinese patients undergoing thoracic surgery: A multicenter prospective observational study

INTRODUCTION

The multicenter CHAMPION study aimed to assess the impact of smoking cessation on post-operative complications (PCs) and smoking cessation patterns in Chinese patients undergoing lung surgery.

METHODS

Patients undergoing elective lung surgery were prospectively enrolled from three major tertiary centers in China. Patients were categorized as smokers or quitters before surgery. Baseline characteristics and smoking status were analyzed. The incidence of PCs and pulmonary PCs (PPCs), smoking relapse rate, and causes within six months post-operatively were investigated. The questionnaire was conducted in all patients and 30 healthcare professionals (HCPs), regarding the awareness and effectiveness of smoking cessation methods.

RESULTS

Of the 276 enrolled patients, 213 (77.2%) were smokers and 63 (22.8%) were quitters; 76.4% were diagnosed with primary lung cancer. PCs occurred in 13.8% of patients, with similar proportions in smokers (14.1%) and quitters (12.7%). PPCs occurred in 9.8% of patients with no significant differences between smokers and quitters (9.4% vs 11.1%, p=0.70). At six months, 9.2% of patients relapsed, with a lower rate in quitters compared to smokers (3.3% vs 11.0%, p=0.01). HCPs exhibited higher awareness of smoking cessation methods than patients. Perceived effectiveness of smoking cessation methods from the patients were low.

CONCLUSIONS

In patients undergoing lung surgery with a low risk of PCs, active smoking does not significantly increase the risk of PCs or PPCs relative to quitters, suggesting that there is likely no need to postpone lung surgery for those who have not yet quit smoking. However, further large-scale studies are necessary to confirm these findings.

A practical guide for perioperative smoking cessation

The perioperative management of patients who are smokers presents anesthesiologists with various challenges related to respiratory, circulatory, and other clinical problems. Regarding 30-day postoperative outcomes, smokers have higher risks of mortality and complications than non-smokers, including death, pneumonia, unplanned tracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, and stroke. Given the benefits of smoking cessation and the adverse effects of smoking on perioperative patient management, patients should quit smoking long before surgery. However, anesthesiologists cannot address these issues alone. The Japanese Society of Anesthesiologists established guidelines in 2015 (published in a medical journal in 2017) to enlighten surgical staff members and patients regarding perioperative tobacco cessation. The primary objective of perioperative smoking cessation is to reduce the risks of adverse cardiovascular and respiratory events, wound infection, and other perioperative complications. Perioperative preparations constitute a powerful teachable moment, a "golden opportunity" for smoking cessation to achieve improved primary disease outcomes and prevent the occurrence of tobacco-related conditions. This review updates the aforementioned guidelines as a practical guide to cover the nuts and bolts of perioperative smoking cessation. Its goal is to assist surgeons, anesthesiologists, and other medical professionals and to increase patients' awareness of smoking risks before elective surgery.

Offering lung resection to current smokers: An opportunity for more equitable care

OBJECTIVE

Minority patients with lung cancer are less likely to undergo surgical resection and experience worse survival than non-Hispanic White patients. Currently, 40% of thoracic surgeons require smoking cessation before surgery, which may disproportionately affect minority patients. Our objective was to assess the risk of smoking status on postoperative morbidity and mortality among patients with lung cancer.

METHODS

A prospectively maintained institutional database was queried for all patients who underwent surgical resection of a primary lung malignancy between 2006 and 2020. Operative mortality, major morbidity, and a composite of morbidity and mortality were compared between current smokers and prior smokers.

RESULTS

A total of 601 patients underwent resection, and 236 (39.3%) were current smokers. Current smokers were more likely to be younger (P < .01), to have a greater pack-years history (P = .03), and to have worse pulmonary function test results (P < .01). Pretreatment stage, surgical approach, and extent of resection were similar between groups. There was no difference in operative mortality (0.9% vs 1.9%, P = .49), major morbidity (12.7% vs 9.3%, P = .19), or composite major morbidity and mortality between groups (13.1% vs 9.3%, P = .14). After adjusting for pulmonary function status, current smoking status was not associated with mortality or major morbidity on multivariable logistic regression (odds ratio, 1.51; 95% confidence interval, 0.76-3.03, P = .24).

CONCLUSIONS

Current smokers experienced similar rates of mortality and major morbidity as prior smokers. In the context of continued racial and ethnic disparities in lung cancer survival, in particular decreased resection rates among minorities, smoking cessation requirements should not delay or prevent operative intervention for lung cancer.

Correlation Between Smoking Status and Short-term Outcome of Thoracoscopic Surgery for Lung Cancer

BACKGROUND

Smoking has a major role in the risk of postoperative pulmonary complications. This study aimed to elucidate the correlation between smoking status and pulmonary complications after thoracoscopic surgery for lung cancer.

METHODS

A total of 1751 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between April 2011 and March 2020 were assessed. The rate of pulmonary complications was evaluated according to smoking status and preoperative duration of smoking cessation. Univariate and multivariate logistic regression analyses were performed.

RESULTS

Pulmonary complications were observed in 50 patients (2.9%), whereas 3 (0.2%) died within 90 days of surgery. The rate of pulmonary complications was higher in smokers than in nonsmokers (4.6% vs 0.9%; P < .001), and smoking history was an independent risk factor for pulmonary complications (odds ratio, 3.31; P = .007). The complication rate in patients with a cessation period of more than 2 months was significantly lower than that in patients who ceased smoking within 2 months (4.0% vs 8.5%; P = .043), but it was still higher than that in nonsmokers (4.0% vs 0.9%; P < .001). In the multivariable analysis for smokers, preoperative short-term smoking cessation within 2 months, male sex, histologic type, tumor size, and cardiopulmonary comorbidities were associated with pulmonary complications instead of pack-year smoking history.

CONCLUSIONS

Smoking habits and preoperative smoking cessation were independently associated with pulmonary complications after thoracoscopic surgery for lung cancer. A preoperative smoking cessation period of 2 months or more is preferable for reducing the risk of such complications.

Preoperative Cumulative Smoking Dose on Lung Cancer Surgery in a Japanese Nationwide Database

BACKGROUND

Smoking is a known risk factor for postoperative mortality and morbidity. However, the significance of cumulative smoking dose in preoperative risk assessment has not been established. We examined the influence of preoperative cumulative smoking dose on surgical outcomes after lobectomy for primary lung cancer.

METHODS

A total of 80,989 patients with primary lung cancer undergoing lobectomy from 2014 to 2016 were enrolled. Preoperative cumulative smoking dose was categorized by pack-years (PY): nonsmokers, PY = 0; light smokers, 0 < PY < 10; moderate smokers, 10 ≤ PY < 30; and heavy smokers, 30 ≤ PY. The risk of short-term outcomes was assessed according to PY by multivariable analysis adjusted for other covariates.

RESULTS

Postoperative 30-day mortality, as well as pulmonary, cardiovascular, and infectious complications, increased with preoperative PY. Multivariable analysis revealed that the odds ratios (ORs) for postoperative mortality compared with nonsmokers were 1.76 for light smokers (P = .044), 1.60 for moderate smokers (P = .026), and 1.73 for heavy smokers (P = .003). The ORs for pulmonary complications compared with nonsmokers were 1.20 for light smokers (P = .022), 1.40 for moderate smokers (P < .001), and 1.72 for heavy smokers (P < .001). Heavy smokers had a significantly increased risk of postoperative cardiovascular (OR, 1.26; P = .002) and infectious (OR, 1.39; P = .007) complications compared with nonsmokers.

CONCLUSIONS

The risk of mortality and morbidity after lung resection could be predicted according to preoperative cumulative smoking dose. These findings contribute to the development of strategies in perioperative management of lung resection patients.

Pre- and postoperative respiratory muscle strength, body mass index and fasting glucose profile of patients with type 2 diabetes mellitus submitted to metabolic surgery

Abstract Introduction: The lung is considered a target organ in diabetes mellitus as a consequence of alterations secondary to chronic hyperglycemia that compromise respiratory muscle strength. Metabolic surgery for improving diabetes mellitus has beneficial effects on weight loss and glucose metabolism. Objective: The objective of this study was to evaluate the respiratory muscle strength, assessed by MIP and MEP, body mass index (BMI) and fasting glucose profile of patients with type 2 diabetes mellitus before and after metabolic surgery without gastric resection. Method: Seventeen patients with type 2 diabetes mellitus participated in the study. The participants had a mean age of 44.8 ± 11.81 years. Results: The results showed a significant decrease of MEP values in the immediate postoperative period when compared to the preoperative period (p=0.001), while no significant results were obtained for MIP. Regarding BMI and fasting glucose, significant weight loss and a significant reduction in fasting glucose levels were observed in the late postoperative period (p=0.006 and p=0.007, respectively). Conclusion: The MIP and MEP were reestablished and satisfactory results were obtained for BMI and fasting glucose in the late postoperative period. Further studies are needed to monitor patients in the pre- and postoperative period of metabolic surgery, identifying complications and acting on the care and recovery of these patients.