Association of Smoking with Early Postoperative Outcomes in Patients Open Access

Dong, Xueyuan (Spring 2018)

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Background: There is limited published evidence on the association of smoking with early postoperative outcomes in patients who underwent isolated heart valve surgery.

Methods: Data prospectively collected from 1,024 patients with surgical aortic valve replacement (SAVR) or mitral valve replacement/repair (SMVR) between January 2002 and September 2017 at Emory University hospitals (Atlanta, Georgia, US) and entered into the Society of Thoracic Surgeons (STS) national database were retrospectively analyzed. Descriptive summary statistics were provided for demographic characteristics, risk factors, preoperative cardiac status and operative factors, stratified by smoking status. Linear regression was used to assess the association between smoking and continuous outcomes, namely: postoperative stay days in hospital and total ICU hours, which were both log-transformed. Logistic regression was used to evaluate the association between smoking and dichotomous outcomes, namely: postoperative in-hospital events, 30-day mortality, and 30-day re-admission. Finally, age, race, gender, family history of premature CAD, hypertension, obesity, dyslipidemia, prior MI, surgeon's experience in heart valve surgery, diseased vessels, emergent/urgent status, procedure type, and cardioplegia use were added to the regression models to estimate adjusted measures of effect.

Results: Among 1,024 patients with SAVR or SMVR included in the study, 120 (11.7%) were current smokers, 288 (28.1%) were former smokers and 616 (60.2%) were never smokers. While there were no significant differences in postoperative stay days, total ICU hours, postoperative in-hospital events or 30-day re-admission between former and current smokers and never smokers, current smokers had significantly higher overall postoperative 30-day mortality (OR = 3.22, 95% CI (1.26, 8.28)) compared to  never smokers. Moreover, higher postoperative 30-day mortality occurred in both former and current smokers aged ≥ 70 years (former: OR = 3.36, 95% CI (1.33, 8.51); current: OR = 8.76, 95% CI (2.01, 38.1)), who were white (former: OR = 2.41, 95% CI (1.13, 5.12); current: OR = 4.04, 95% CI (1.42, 11.5)) or who were male (former: OR = 3.15, 95% CI (1.13, 8.78); current: OR = 4.85, 95% CI (1.41, 16.7)).

Conclusion: Smoking is significantly associated with higher postoperative 30-day mortality among patients who underwent isolated heart valve surgery, particularly among those aged ≥ 70 years, who were white or who were male.

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