Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries
Issued Date
2025-06-01
Resource Type
ISSN
09528180
eISSN
18734529
Scopus ID
2-s2.0-105005015590
Journal Title
Journal of Clinical Anesthesia
Volume
104
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Anesthesia Vol.104 (2025)
Suggested Citation
Dorland G., Saadat W., van Meenen D.M.P., Neto A.S., Hiesmayr M., Hollmann M.W., Mills G.H., Vidal Melo M.F., Putensen C., Schmid W., Severgnini P., Wrigge H., de Abreu M.G., Schultz M.J., Hemmes S.N.T., 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., Djonoviċ-Omanoviċ 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 J.P., Erceg G., Dvorscak M.B., Mazul-Sunko B., Pavicic A.M., 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 H.H., Metwally T., Abdel-Razek A., El-Shaarawy A.M., Hasan W.F., Ahmed A.G., Yassin H. Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries. Journal of Clinical Anesthesia Vol.104 (2025). doi:10.1016/j.jclinane.2025.111856 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110264
Title
Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries
Author(s)
Dorland G.
Saadat W.
van Meenen D.M.P.
Neto A.S.
Hiesmayr M.
Hollmann M.W.
Mills G.H.
Vidal Melo M.F.
Putensen C.
Schmid W.
Severgnini P.
Wrigge H.
de Abreu M.G.
Schultz M.J.
Hemmes S.N.T.
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.
Djonoviċ-Omanoviċ 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 J.P.
Erceg G.
Dvorscak M.B.
Mazul-Sunko B.
Pavicic A.M.
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 H.H.
Metwally T.
Abdel-Razek A.
El-Shaarawy A.M.
Hasan W.F.
Ahmed A.G.
Yassin H.
Saadat W.
van Meenen D.M.P.
Neto A.S.
Hiesmayr M.
Hollmann M.W.
Mills G.H.
Vidal Melo M.F.
Putensen C.
Schmid W.
Severgnini P.
Wrigge H.
de Abreu M.G.
Schultz M.J.
Hemmes S.N.T.
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.
Djonoviċ-Omanoviċ 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 J.P.
Erceg G.
Dvorscak M.B.
Mazul-Sunko B.
Pavicic A.M.
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 H.H.
Metwally T.
Abdel-Razek A.
El-Shaarawy A.M.
Hasan W.F.
Ahmed A.G.
Yassin H.
Author's Affiliation
Fayoum University Hospital
Beni Suef University Hospital
Mahidol Oxford Tropical Medicine Research Unit
Kepler Universitätsklinikum
Melbourne Medical School
KBC Osijek
Klinički Bolnički Centar Split
Klinički Bolnički Centar Rijeka
Universitair Ziekenhuis Brussel
General Hospital Karlovac
Dr. Josip Bencevic General Hospital
University Hospital in Ostrava
Ziekenhuis Oost-Limburg
Universitair Ziekenhuis Gent
KBC Zagreb
Universitätsklinikum Bonn
Columbia University
Massachusetts General Hospital
Medizinische Fakultät Carl Gustav Carus
Faculty of Medicine
Clinical Hospital Merkur
General Hospital Sveti Duh
Fakultni Nemocnice Brno
Cleveland Clinic Foundation
Monash University
Fakultní Nemocnice Hradec Králové
Hospital Israelita Albert Einstein
The Netherlands Cancer Institute
Cliniques Universitaires Saint-Luc
Medizinische Universität Wien
Nuffield Department of Medicine
Università degli Studi dell'Insubria
LKH-Universitätsklinikum Graz
Austin Hospital
The University of Sheffield
Amsterdam UMC - University of Amsterdam
Martin−Luther−University of Halle−Wittenberg
Nemocnice Znojmo
Bermannstrost Hospital Halle
General Hospital "Prim. Dr. Abdulah Nakas"
European Society of Anaesthesiology
AZ Maria Middelares
General Hospital Čakovec
El-Sahel Teaching Hospital
Beni Suef University Hospital
Mahidol Oxford Tropical Medicine Research Unit
Kepler Universitätsklinikum
Melbourne Medical School
KBC Osijek
Klinički Bolnički Centar Split
Klinički Bolnički Centar Rijeka
Universitair Ziekenhuis Brussel
General Hospital Karlovac
Dr. Josip Bencevic General Hospital
University Hospital in Ostrava
Ziekenhuis Oost-Limburg
Universitair Ziekenhuis Gent
KBC Zagreb
Universitätsklinikum Bonn
Columbia University
Massachusetts General Hospital
Medizinische Fakultät Carl Gustav Carus
Faculty of Medicine
Clinical Hospital Merkur
General Hospital Sveti Duh
Fakultni Nemocnice Brno
Cleveland Clinic Foundation
Monash University
Fakultní Nemocnice Hradec Králové
Hospital Israelita Albert Einstein
The Netherlands Cancer Institute
Cliniques Universitaires Saint-Luc
Medizinische Universität Wien
Nuffield Department of Medicine
Università degli Studi dell'Insubria
LKH-Universitätsklinikum Graz
Austin Hospital
The University of Sheffield
Amsterdam UMC - University of Amsterdam
Martin−Luther−University of Halle−Wittenberg
Nemocnice Znojmo
Bermannstrost Hospital Halle
General Hospital "Prim. Dr. Abdulah Nakas"
European Society of Anaesthesiology
AZ Maria Middelares
General Hospital Čakovec
El-Sahel Teaching Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Introduction: 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.