Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery

Sebastian T. Lugg, Theofano Tikka, Paula J. Agostini, Amy Kerr, Kerry Adams, Maninder S. Kalkat, Richard S. Steyn, Pala B. Rajesh, Ehab Bishay, David R. Thickett, Babu Naidu

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    Background: Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival.
    Methods: A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010-2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival.
    Results: Four hundred and sixty-two patients included 111 (24%) current smokers, 55 (12%) ex-smokers <6 weeks, 245 (53%) ex-smokers ≥6 weeks and 51 (11%) never smokers. PPC occurred in 60 (13%) patients in total. Compared to never smokers, current smokers had a higher frequency of PPC (22% vs. 2%, p = 0.004), higher frequency of ITU admission (14% vs. 0%; p = 0.001) and a longer median (IQR) hospital LOS (6 [5] vs. 5 [2]; p = 0.001). In the ex-smokers there was a trend for a lower frequency of PPC (<6 weeks, 10.9% vs. ≥6 weeks, 11.8%) and ITU admission (<6 weeks, 5.5% vs. ≥6 weeks, 4.5%), but there was no difference between the <6 weeks or ≥6 weeks ex-smoking groups prior to surgery. There was no significant difference in long-term survival found between the groups of differing smoking status (median follow-up 29.8 months, 95%CI 28.4-31.1).
    Conclusion: Current smokers have higher postoperative morbidity; this risk reduces following smoking cessation but 6 weeks does not appear to identify a time-point where differences in outcomes are noted.
    LanguageEnglish
    Pages8
    JournalJournal of Cardiovascular Surgery
    Volume12
    Issue number52
    DOIs
    Publication statusPublished - 19 Jun 2017

    Fingerprint

    Smoking Cessation
    Lung Neoplasms
    Lung
    Length of Stay
    Smoking
    Non-Small Cell Lung Carcinoma
    Survival
    Patient Readmission
    Incidence
    Thorax
    Therapeutics
    Prospective Studies
    Morbidity

    Keywords

    • aged
    • carcinoma, non-small-cell lung/mortality
    • female
    • follow-up studies
    • humans
    • incidence
    • lung neoplasms
    • male
    • pneumonectomy/adverse effects
    • postoperative complications
    • prospective studies
    • risk factors
    • smoking/adverse effects
    • smoking cessation methods
    • thoracic surgery
    • time Factors
    • United Kingdom

    Cite this

    Lugg, Sebastian T. ; Tikka, Theofano ; Agostini, Paula J. ; Kerr, Amy ; Adams, Kerry ; Kalkat, Maninder S. ; Steyn, Richard S. ; Rajesh, Pala B. ; Bishay, Ehab ; Thickett, David R. ; Naidu, Babu. / Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery. In: Journal of Cardiovascular Surgery. 2017 ; Vol. 12, No. 52. pp. 8.
    @article{589ff6b0ab7246e68b03010eec62ba7d,
    title = "Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery",
    abstract = "Background: Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival.Methods: A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010-2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival.Results: Four hundred and sixty-two patients included 111 (24{\%}) current smokers, 55 (12{\%}) ex-smokers <6 weeks, 245 (53{\%}) ex-smokers ≥6 weeks and 51 (11{\%}) never smokers. PPC occurred in 60 (13{\%}) patients in total. Compared to never smokers, current smokers had a higher frequency of PPC (22{\%} vs. 2{\%}, p = 0.004), higher frequency of ITU admission (14{\%} vs. 0{\%}; p = 0.001) and a longer median (IQR) hospital LOS (6 [5] vs. 5 [2]; p = 0.001). In the ex-smokers there was a trend for a lower frequency of PPC (<6 weeks, 10.9{\%} vs. ≥6 weeks, 11.8{\%}) and ITU admission (<6 weeks, 5.5{\%} vs. ≥6 weeks, 4.5{\%}), but there was no difference between the <6 weeks or ≥6 weeks ex-smoking groups prior to surgery. There was no significant difference in long-term survival found between the groups of differing smoking status (median follow-up 29.8 months, 95{\%}CI 28.4-31.1).Conclusion: Current smokers have higher postoperative morbidity; this risk reduces following smoking cessation but 6 weeks does not appear to identify a time-point where differences in outcomes are noted.",
    keywords = "aged, carcinoma, non-small-cell lung/mortality, female, follow-up studies, humans, incidence, lung neoplasms, male, pneumonectomy/adverse effects, postoperative complications, prospective studies, risk factors, smoking/adverse effects, smoking cessation methods, thoracic surgery, time Factors, United Kingdom",
    author = "Lugg, {Sebastian T.} and Theofano Tikka and Agostini, {Paula J.} and Amy Kerr and Kerry Adams and Kalkat, {Maninder S.} and Steyn, {Richard S.} and Rajesh, {Pala B.} and Ehab Bishay and Thickett, {David R.} and Babu Naidu",
    year = "2017",
    month = "6",
    day = "19",
    doi = "10.1186/s13019-017-0614-4",
    language = "English",
    volume = "12",
    pages = "8",
    journal = "Journal of Cardiovascular Surgery",
    issn = "1749-8090",
    number = "52",

    }

    Lugg, ST, Tikka, T, Agostini, PJ, Kerr, A, Adams, K, Kalkat, MS, Steyn, RS, Rajesh, PB, Bishay, E, Thickett, DR & Naidu, B 2017, 'Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery' Journal of Cardiovascular Surgery, vol. 12, no. 52, pp. 8. https://doi.org/10.1186/s13019-017-0614-4

    Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery. / Lugg, Sebastian T.; Tikka, Theofano; Agostini, Paula J.; Kerr, Amy; Adams, Kerry; Kalkat, Maninder S.; Steyn, Richard S.; Rajesh, Pala B.; Bishay, Ehab; Thickett, David R.; Naidu, Babu.

    In: Journal of Cardiovascular Surgery, Vol. 12, No. 52, 19.06.2017, p. 8.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery

    AU - Lugg, Sebastian T.

    AU - Tikka, Theofano

    AU - Agostini, Paula J.

    AU - Kerr, Amy

    AU - Adams, Kerry

    AU - Kalkat, Maninder S.

    AU - Steyn, Richard S.

    AU - Rajesh, Pala B.

    AU - Bishay, Ehab

    AU - Thickett, David R.

    AU - Naidu, Babu

    PY - 2017/6/19

    Y1 - 2017/6/19

    N2 - Background: Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival.Methods: A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010-2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival.Results: Four hundred and sixty-two patients included 111 (24%) current smokers, 55 (12%) ex-smokers <6 weeks, 245 (53%) ex-smokers ≥6 weeks and 51 (11%) never smokers. PPC occurred in 60 (13%) patients in total. Compared to never smokers, current smokers had a higher frequency of PPC (22% vs. 2%, p = 0.004), higher frequency of ITU admission (14% vs. 0%; p = 0.001) and a longer median (IQR) hospital LOS (6 [5] vs. 5 [2]; p = 0.001). In the ex-smokers there was a trend for a lower frequency of PPC (<6 weeks, 10.9% vs. ≥6 weeks, 11.8%) and ITU admission (<6 weeks, 5.5% vs. ≥6 weeks, 4.5%), but there was no difference between the <6 weeks or ≥6 weeks ex-smoking groups prior to surgery. There was no significant difference in long-term survival found between the groups of differing smoking status (median follow-up 29.8 months, 95%CI 28.4-31.1).Conclusion: Current smokers have higher postoperative morbidity; this risk reduces following smoking cessation but 6 weeks does not appear to identify a time-point where differences in outcomes are noted.

    AB - Background: Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival.Methods: A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010-2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival.Results: Four hundred and sixty-two patients included 111 (24%) current smokers, 55 (12%) ex-smokers <6 weeks, 245 (53%) ex-smokers ≥6 weeks and 51 (11%) never smokers. PPC occurred in 60 (13%) patients in total. Compared to never smokers, current smokers had a higher frequency of PPC (22% vs. 2%, p = 0.004), higher frequency of ITU admission (14% vs. 0%; p = 0.001) and a longer median (IQR) hospital LOS (6 [5] vs. 5 [2]; p = 0.001). In the ex-smokers there was a trend for a lower frequency of PPC (<6 weeks, 10.9% vs. ≥6 weeks, 11.8%) and ITU admission (<6 weeks, 5.5% vs. ≥6 weeks, 4.5%), but there was no difference between the <6 weeks or ≥6 weeks ex-smoking groups prior to surgery. There was no significant difference in long-term survival found between the groups of differing smoking status (median follow-up 29.8 months, 95%CI 28.4-31.1).Conclusion: Current smokers have higher postoperative morbidity; this risk reduces following smoking cessation but 6 weeks does not appear to identify a time-point where differences in outcomes are noted.

    KW - aged

    KW - carcinoma, non-small-cell lung/mortality

    KW - female

    KW - follow-up studies

    KW - humans

    KW - incidence

    KW - lung neoplasms

    KW - male

    KW - pneumonectomy/adverse effects

    KW - postoperative complications

    KW - prospective studies

    KW - risk factors

    KW - smoking/adverse effects

    KW - smoking cessation methods

    KW - thoracic surgery

    KW - time Factors

    KW - United Kingdom

    UR - https://cardiothoracicsurgery.biomedcentral.com/

    U2 - 10.1186/s13019-017-0614-4

    DO - 10.1186/s13019-017-0614-4

    M3 - Article

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    SP - 8

    JO - Journal of Cardiovascular Surgery

    T2 - Journal of Cardiovascular Surgery

    JF - Journal of Cardiovascular Surgery

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    ER -