Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis.
ABSTRACT To examine existing smoking studies that compare surgical patients who have recently quit smoking with those who continue to smoke to provide an evidence-based recommendation for front-line staff. Concerns have been expressed that stopping smoking within 8 weeks before surgery may be detrimental to postoperative outcomes. This has generated considerable uncertainty even in health care systems that consider smoking cessation advice in the hospital setting an important priority. Smokers who stop smoking shortly before surgery (recent quitters) have been reported to have worse surgical outcomes than early quitters, but this may indicate only that recent quitting is less beneficial than early quitting, not that it is risky.
Systematic review with meta-analysis.
British Nursing Index (BNI), The Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PsycINFO to May 2010, and reference lists of included studies.
Studies were included that allow a comparison of postoperative complications in patients undergoing any type of surgery who stopped smoking within 8 weeks prior to surgery and those who continued to smoke.
Two reviewers independently screened potential studies and assessed their methodologic quality. Data were entered into 3 separate meta-analyses that considered all available studies, studies with a low risk of bias that validated self-reported abstinence (to assess possible benefits), and studies of pulmonary complications only (to assess possible risks). Results were combined by using a random-effects model, and heterogeneity was evaluated by using the I(2) statistic.
Nine studies met the inclusion criteria. One found a beneficial effect of recent quitting compared with continuing smoking, and none identified any detrimental effects. In meta-analyses, quitting smoking within 8 weeks before surgery was not associated with an increase or decrease in overall postoperative complications for all available studies (relative risk [RR], 0.78; 95% confidence interval [CI], 0.57-1.07), for a group of 3 studies with high-quality scores (RR, 0.57; 95% CI, 0.16-2.01), or for a group of 4 studies that specifically evaluated pulmonary complications (RR, 1.18; 95% CI, 0.95-1.46).
Existing data indicate that the concern that stopping smoking only a few weeks prior to surgery might worsen clinical outcomes is unfounded. Further larger studies would be useful to arrive at a more robust conclusion. Patients should be advised to stop smoking as early as possible, but there is no evidence to suggest that health professionals should not be advising smokers to quit at any time prior to surgery.
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ABSTRACT: Background. No studies report robust data on the national incidence and risk factors associated with catastrophic medical outcomes following free tissue transfer. Methods. The American College of Surgeons (ACS) multicenter, prospective National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent free tissue transfer between 2006 and 2011. Multivariable logistic regression was used for statistical analysis. Results. Over the 6-year study period 2,349 patients in the NSQIP database underwent a free tissue transfer procedure. One hundred and twenty-two patients had at least one catastrophic medical outcome (5.2%). These 122 patients had 151 catastrophic medical outcomes, including 93 postoperative respiratory failure events (4.0%), 14 pulmonary emboli (0.6%), 13 septic shock events (0.5%), 12 myocardial infarctions (0.5%), 6 cardiac arrests (0.3%), 4 strokes (0.2%), 1 coma (0.0%), and 8 deaths (0.3%). Total length of hospital stay was on average 14.7 days longer for patients who suffered a catastrophic medical complication (P < 0.001). Independent risk factors were identified. Conclusions. Free tissue transfer is a proven and safe technique. Catastrophic medical complications were infrequent but added significantly to length of hospital stay and patient morbidity.Plastic surgery international. 01/2014; 2014:704206.
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ABSTRACT: Objectifs Le patient tabagique bénéficiant d’une intervention de chirurgie plastique est exposé à un risque majoré de complications péri- et postopératoires. Il nous semblait utile d’établir une mise au point sur le retentissement négatif, en particulier cicatriciel, du tabagisme et sur les bénéfices incontestables du sevrage. Nous souhaitons proposer un délai minimal de sevrage pré- et postopératoire en vue de réduire les risques et d’optimiser les résultats de l’intervention. Méthodes Une revue de la littérature a été réalisée sur la période 1972–2014 en interrogeant cinq bases de données (Medline, PubMed Central, Cochrane library, Pascal et Web of Science). Résultats La fumée de cigarette agit de manière diffuse et multifactorielle dans l’organisme. L’hypoxie et l’ischémie tissulaire ainsi que les désordres immunitaires induits par le tabac sont responsables de l’altération du processus cicatriciel. Une partie de ces effets est réversible au sevrage. Les données de la littérature conseillent un délai d’arrêt du tabagisme préopératoire situé entre 3 et 8 semaines et allant jusqu’à 4 semaines postopératoires. L’utilisation de traitements substitutifs nicotiniques double le taux d’abstinence à court terme. Le chirurgien doit s’aider d’un tabacologue en cas de dépendance importante de son patient. Conclusions Un sevrage tabagique total de 4 semaines préopératoires et jusqu’à la cicatrisation primaire du site opératoire, soit 2 semaines postopératoires, semble optimiser les conditions chirurgicales sans majorer le risque anesthésique. Un accompagnement du sevrage aussi bien humain que médicamenteux est recommandé.Annales de Chirurgie Plastique Esthétique 10/2014; 60(1). · 0.59 Impact Factor
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ABSTRACT: Despite the close link between cigarette smoking and the development of gastric cancer, little is known about the effects of cigarette smoking on surgical outcomes after gastric cancer surgery. The aim of this study was to investigate whether preoperative smoking status and the duration of smoking cessation were associated with short-term surgical consequences in gastric cancer surgery.Gastric Cancer 08/2014; · 4.83 Impact Factor