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Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries

Lookup NU author(s): Dr Ahmed Chishti, Dr Alistair Cain

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Abstract

© 2025 The AuthorsIntroduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. Conclusion: The occurrence of PPCs in smokers is not different from non–smokers. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). Prior presentation: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.


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Author(s): Dorland G, Saadat W, van Meenen DMP, Neto AS, Hiesmayr M, Hollmann MW, Mills GH, Vidal Melo MF, Putensen C, Schmid W, Severgnini P, Wrigge H, de Abreu MG, Schultz MJ, Hemmes SNT, Kroell W, Metzler H, Struber G, Wegscheider T, Gombotz H, Hiesmayr M, Schmid W, Urbanek B, Kahn D, Momeni M, Pospiech A, Lois F, Forget P, Grosu I, Poelaert J, van Mossevelde V, van Malderen M-C, Dylst D, van Melkebeek J, Beran M, de Hert S, De Baerdemaeker L, Heyse B, Van Limmen J, Wyffels P, Jacobs T, Roels N, De Bruyne A, van de Velde S, Leva B, Damster S, Plichon B, Juros-Zovko M, Djonovic-Omanovic D, Pernar S, Zunic J, Miskovic P, Zilic A, Kvolik S, Ivic D, Azenic-Venzera D, Skiljic S, Vinkovic H, Oputric I, Juricic K, Frkovic V, Kopic J, Mirkovic I, Karanovic N, Carev M, Dropulic N, Saric JP, Erceg G, Dvorscak MB, Mazul-Sunko B, Pavicic AM, Goranovic T, Maldini B, Radocaj T, Gavranovic Z, Mladic-Batinica I, Sehovic M, Stourac P, Harazim H, Smekalova O, Kosinova M, Kolacek T, Hudacek K, Drab M, Brujevic J, Vitkova K, Jirmanova K, Volfova I, Dzurnakova P, Liskova K, Dudas R, Filipsky R, el Kafrawy S, Abdelwahab HH, Metwally T, Abdel-Razek A, El-Shaarawy AM, Hasan WF, Ahmed AG, Yassin H, Magdy M, Abdelhady M, Mahran M, Herodes E, Kivik P, Oganjan J, Aun A, Sormus A, Sarapuu K, Mall M, Karjagin J, Futier E, Petit A, Gerard A, Marret E, Solier M, Jaber S, Prades A, Krassler J, Merzky S, de Abreu MG, Uhlig C, Kiss T, Bundy A, Bluth T, Gueldner A, Spieth P, Scharffenberg M, Thiem DT, Koch T, Treschan T, Schaefer M, Bastin B, Geib J, Weiss M, Kienbaum P, Pannen B, Gottschalk A, Konrad M, Westerheide D, Schwerdtfeger B, Wrigge H, Simon P, Reske A, Nestler C, Valsamidis D, Stroumpoulis K, Antholopoulos G, Andreou A, Karapanos D, Theodoraki K, Gkiokas G, Tasoulis M-K, Sidiropoulou T, Zafeiropoulou F, Florou P, Pandazi A, Tsaousi G, Nouris C, Pourzitaki C, Bystritski D, Pizov R, Eden A, Pesce CV, Campanile A, Marrella A, Grasso S, De Michele M, Bona F, Giacoletto G, Sardo E, Giancarlo L, Sottosanti V, Solca M, Volta CA, Spadaro S, Verri M, Ragazzi R, Zoppellari R, Cinnella G, Raimondo P, La Bella D, Mirabella L, D'antini D, Pelosi P, Molin A, Brunetti I, Gratarola A, Pellerano G, Sileo R, Pezzatto S, Montagnani L, Pasin L, Landoni G, Zangrillo A, Beretta L, Di Parma AL, Tarzia V, Dossi R, Sassone ME, Sances D, Tredici S, Spano G, Castellani G, Delunas L, Peradze S, Venturino M, Arpino I, Sher S, Tommasino C, Rapido F, Morelli P, Vargas M, Servillo G, Cortegiani A, Raineri SM, Montalto F, Russotto V, Giarratano A, Baciarello M, Generali M, Cerati G, Leykin Y, Bressan F, Bartolini V, Zamidei L, Brazzi L, Liperi C, Sales G, Pistidda L, Severgnini P, Brugnoni E, Musella G, Bacuzzi A, Muhardri D, Gecaj-Gashi A, Sada F, Bytyqi A, Karbonskiene A, Aukstakalniene R, Teberaite Z, Salciute E, Tikuisis R, Miliauskas P, Jurate S, Kontrimaviciute E, Tomkute G, Xuereb J, Bezzina M, Borg FJ, Hemmes S, Schultz M, Hollmann M, Wiersma I, Binnekade J, Bos L, Boer C, Duvekot A, Veld BI, 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Publication type: Article

Publication status: Published

Journal: Journal of Clinical Anesthesia

Year: 2025

Volume: 104

Print publication date: 01/06/2025

Online publication date: 14/05/2025

Acceptance date: 28/04/2025

ISSN (print): 0952-8180

ISSN (electronic): 1873-4529

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.jclinane.2025.111856

DOI: 10.1016/j.jclinane.2025.111856


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