THE IMPACT OF SMOKING ON OUTCOMES AFTER CARDIAC SURGERY

• Published in: Journal of cardiothoracic and vascular anesthesia 2024-12, Vol.38 (12), p.76-76
• Main Authors: Sewart, Emma, Isted, Alexander, Wong, Kitty, Whitaker, Donald, Hinchliffe, Robert, Kunst, Gudrun, Mouton, Ronelle
• Format: Article
• Language: English
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2024.09.118

Tobacco smoking is a risk factor for adverse outcomes after surgery. Although perioperative cessation interventions are effective, the prevalence of smoking remains higher amongst surgical patients (25%) than the general UK population (13%). Contemporary UK data on the burden of smoking in people undergoing cardiac surgery and the impact of smoking on perioperative outcomes are lacking. This study evaluates the prevalence of smoking in the UK elective cardiac surgery population and compares postoperative outcomes between groups of different smoking status. The National Adult Cardiac Surgery Audit collects data on all adults undergoing cardiac surgery in England, Wales and Northern Ireland. Patients were included in this retrospective analysis if they underwent Coronary Artery Bypass Grafting (CABG), valve surgery or surgery to the thoracic aorta between January 2012 and December 2022. Those who underwent non-elective surgery or opted out of data use for research were excluded. Smoking status was classified as current smoker (regularly smokes one or more cigarettes per day), ex-smoker (not smoked within one month) and non-smoker (never smoked). Prevalence of smoking, change over time and association with clinical and procedural characteristics were explored using logistic regression. The incidences of postoperative complications were compared between smoking status groups (smokers vs. non-smokers and smokers vs. ex-smokers) using logistic regression and Cox proportional hazards regression respectively, adjusted for EuroSCORE II. Subgroup analysis was performed by procedure type. Of the 170,532 included patients, 7.7% were current smokers (n=13,200), 48.4% were ex-smokers (n=82,541) and 43.9% were non-smokers (n=74,791). This rate did not change significantly between 2012 and 2022. Patients who were younger, male, or undergoing isolated CABG were more likely to smoke. Overall, the incidence of deep sternal wound infection (DSWI) was higher in smokers (0.6%, n=78) than non-smokers (0.4%, n=301) when adjusted for EuroSCORE II (odds ratio (OR) 1.53; 95% confidence interval (CI) 1.19-1.96; p