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Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries

  • Galina Dorland*
  • , W. Saadat
  • , David M. P. van Meenen
  • , Ary Serpa Neto
  • , Michael Hiesmayr
  • , Markus W. Hollmann
  • , Gary H. Mills
  • , Marcos F. Vidal Melo
  • , Christian Putensen
  • , Werner Schmid
  • , Paolo Severgnini
  • , Hermann Wrigge
  • , Marcelo Gama de Abreu
  • , Marcus J. Schultz
  • , Sabrine N. T. Hemmes
  • , Wolfgang Kroell
  • , Helfried Metzler
  • , Gerd Struber
  • , Thomas Wegscheider
  • , Hans Gombotz
  • Michael Hiesmayr, Werner Schmid, Bernhard Urbanek, David Kahn, Mona Momeni, Audrey Pospiech, Fernande Lois, Patrice Forget, Irina Grosu, Jan Poelaert, Veerle van Mossevelde, Marie-Claire van Malderen, Dimitri Dylst, Jeroen van Melkebeek, Maud Beran, Stefan de Hert, Luc de Baerdemaeker, Bjorn Heyse, Jurgen van Limmen, Piet Wyffels, Tom Jacobs, Nathalie Roels, Ann de Bruyne, Stijn van de Velde, Brigitte Leva, Sandrine Damster, Benoit Plichon, Marina Juros-Zovko, Dejana Djonoviċ-Omanoviċ, Selma Pernar, Josip Zunic, Petar Miskovic, Antonio Zilic, Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric, Kazimir Juricic, Vedran Frkovic, Jasminka Kopic, Ivan Mirkovic, Nenad Karanovic, Mladen Carev, Natasa Dropulic, Jadranka Pavicic Saric, Gorjana Erceg, Matea Bogdanovic Dvorscak, Branka Mazul-Sunko, Anna Marija Pavicic, Tanja Goranovic, Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna Sehovic, Petr Stourac, Hana Harazim, Olga Smekalova, Martina Kosinova, Tomas Kolacek, Kamil Hudacek, Michal Drab, Jan Brujevic, Katerina Vitkova, Katerina Jirmanova, Ivana Volfova, Paula Dzurnakova, Katarina Liskova, Radovan Dudas, Radek Filipsky, Samir el Kafrawy, Hisham Hosny Abdelwahab, Tarek Metwally, Ahmed Abdel-Razek, Ahmed Mostafa el-Shaarawy, Wael Fathy Hasan, Ahmed Gouda Ahmed, Hany Yassin, Mohamed Magdy, Mahdy Abdelhady, Mohamed Mahran, Eiko Herodes, Peeter Kivik, Juri Oganjan, Annika Aun, Alar Sormus, Kaili Sarapuu, Merilin Mall, Juri Karjagin, Emmanuel Futier, Antoine Petit, Adeline Gerard, Emmanuel Marret, Marc Solier, Samir Jaber, Albert Prades, Jens Krassler, Simone Merzky, Marcel Gama de Abreu, Christopher Uhlig, Thomas Kiss, Anette Bundy, Thomas Bluth, Andreas Gueldner, Peter Spieth, Martin Scharffenberg, Denny Tran Thiem, Thea Koch, Tanja Treschan, Maximilian Schaefer, Bea Bastin, Johann Geib, Martin Weiss, Peter Kienbaum, Benedikt Pannen, Andre Gottschalk, Mirja Konrad, Diana Westerheide, Ben Schwerdtfeger, Hermann Wrigge, Philipp Simon, Andreas Reske, Christian Nestler, Dimitrios Valsamidis, Konstantinos Stroumpoulis, Georgios Antholopoulos, Antonis Andreou, Dimitris Karapanos, Kassiani Theodoraki, Georgios Gkiokas, Marios-Konstantinos Tasoulis, Tatiana Sidiropoulou, Foteini Zafeiropoulou, Panagiota Florou, Aggeliki Pandazi, Georgia Tsaousi, Christos Nouris, Chryssa Pourzitaki, Dmitri Bystritski, Reuven Pizov, Arieh Eden, Caterina Valeria Pesce, Annamaria Campanile, Antonella Marrella, Salvatore Grasso, Michele de Michele, Francesco Bona, Gianmarco Giacoletto, Elena Sardo, Luigi Giancarlo, Vicari Sottosanti, Maurizio Solca, Carlo Alberto Volta, Savino Spadaro, Marco Verri, Riccardo Ragazzi, Roberto Zoppellari, Gilda Cinnella, Pasquale Raimondo, Daniela la Bella, Lucia Mirabella, Davide D'antini, Paolo Pelosi, Alexandre Molin, Iole Brunetti, Angelo Gratarola, Giulia Pellerano, Rosanna Sileo, Stefano Pezzatto, Luca Montagnani, Laura Pasin, Giovanni Landoni, Alberto Zangrillo, Luigi Beretta, Ambra Licia di Parma, Valentina Tarzia, Roberto Dossi, Marta Eugenia Sassone, Daniele Sances, Stefano Tredici, Gianluca Spano, Gianluca Castellani, Luigi Delunas, Sopio Peradze, Marco Venturino, Ines Arpino, Sara Sher, Concezione Tommasino, Francesca Rapido, Paola Morelli, Maria Vargas, Giuseppe Servillo, Andrea Cortegiani, Santi Maurizio Raineri, Francesca Montalto, Vincenzo Russotto, Antonino Giarratano, Marco Baciarello, Michela Generali, Giorgia Cerati, Yigal Leykin, Filippo Bressan, Vittoria Bartolini, Lucia Zamidei, Luca Brazzi, Corrado Liperi, Gabriele Sales, Laura Pistidda, Paolo Severgnini, Elisa Brugnoni, Giuseppe Musella, Alessandro Bacuzzi, Dalip Muhardri, Agreta Gecaj-Gashi, Fatos Sada, Adem Bytyqi, Aurika Karbonskiene, Ruta Aukstakalniene, Zivile Teberaite, Erika Salciute, Renatas Tikuisis, Povilas Miliauskas, Sipylaite Jurate, Egle Kontrimaviciute, Gabija Tomkute, John Xuereb, Maureen Bezzina, Francis Joseph Borg, Sabrine Hemmes, Marcus Schultz, Markus Hollmann, Irene Wiersma, Jan Binnekade, Lieuwe Bos, Christa Boer, Anne Duvekot, Bas in 't Veld, Alice Werger, Paul Dennesen, Charlotte Severijns, Jasper de Jong, Jens Hering, Rienk van Beek, Stefan Ivars, Ib Jammer, Alena Breidablik, Katharina Skirstad Hodt, Frode Fjellanger, Manuel Vico Avalos, Jannicke Mellin-Olsen, Elisabeth Andersson, Amir Shafi-Kabiri, Ruby Molina, Stanley Wutai, Erick Morais, Glória Tareco, Daniel Ferreira, Joana Amaral, Maria de Lurdes Goncalves Castro, Susana Cadilha, Sofia Appleton, Suzana Parente, Mariana Correia, Diogo Martins, Angela Monteirosa, Ana Ricardo, Sara Rodrigues, Lucian Horhota, Ioana Marina Grintescu, Liliana Mirea, Ioana Cristina Grintescu, Dan Corneci, Silvius Negoita, Madalina Dutu, Ioana Popescu Garotescu, Daniela Filipescu, Alexandru Bogdan Prodan, Gabriela Droc, Ruxandra Fota, Mihai Popescu, Dana Tomescu, Ana Maria Petcu, Marian Irinel Tudoroiu, Alida Moise, Catalin-Traian Guran, Iorel Gherghina, Dan Costea, Iulia Cindea, Sanda-Maria Copotoiu, Ruxandra Copotoiu, Victoria Barsan, Zsolt Tolcser, Magda Riciu, Septimiu Gheorghe Moldovan, Mihaly Veres, Alexey Gritsan, Tatyana Kapkan, Galina Gritsan, Oleg Korolkov, Alexander Kulikov, Andrey Lubnin, Alexey Ovezov, Pavel Prokoshev, Alexander Lugovoy, Natalia Anipchenko, Andrey Babayants, Irina Komissarova, Karginova Zalina, Valery Likhvantsev, Sergei Fedorov, Aleksandra Lazukic, Jasmina Pejakovic, Dunja Mihajlovic, Zuzana Kusnierikova, Maria Zelinkova, Katarina Bruncakova, Lenka Polakovicova, Villiam Sobona, Barbka Novak-Supe, Ana Pekle-Golez, Miroljub Jovanov, Branka Strazisar, Jasmina Markovic-Bozic, Vesna Novak-Jankovic, Minca Voje, Andriy Grynyuk, Ivan Kostadinov, Alenka Spindler-Vesel, Victoria Moral, Mari Carmen Unzueta, Carlos Puigbo, Josep Fava, Jaume Canet, Enrique Moret, M. nica Rodriguez Nunez, Mar Sendra, Andrea Brunelli, Frederic Rodenas, Pablo Monedero, Francisco Hidalgo Martinez, Maria Jose Yepes Temino, Antonio Martínez Simon, Ana de Abajo Larriba, Alberto Lisi, Gisela Perez, Raquel Martinez, Manuel Granell, Jose Tatay Vivo, Cristina Saiz Ruiz, Jose Antonio de Andrés Ibañez, Ernesto Pastor, Marina Soro, Carlos Ferrando, Mario Defez, Cesar Aldecoa Alvares-Santullano, Rocio Perez, Jesus Rico, Monir Jawad, Yousif Saeed, Lars Gillberg, Zuleyha Kazak Bengisun, Baturay Kansu Kazbek, Nesil Coskunfirat, Neval Boztug, Suat Sanli, Murat Yilmaz, Necmiye Hadimioglu, Nuzhet Mert Senturk, Emre Camci, Semra Kucukgoncu, Zerrin Sungur, Nukhet Sivrikoz, Serpil Ustalar Ozgen, Fevzi Toraman, Onur Selvi, Ozgur Senturk, Mine Yildiz, Bahar Kuvaki, Ferim Gunenc, Semih Kucukguclu, Şule Ozbilgin, Jale Maral, Seyda Canli, Oguzhan Arun, Ali Saltali, Eyup Aydogan, Fatma Nur Akgun, Ceren Sanlikarip, Fatma Mine Karaman, Andriy Mazur, Sergiy Vorotyntsev, Guy Rousseau, Colin Barrett, Lucia Stancombe, Ben Shelley, Helen Scholes, James Limb, Amir Rafi, Lisa Wayman, Jill Deane, David Rogerson, John Williams, Susan Yates, Elaine Rogers, Mark Pulletz, Sarah Moreton, Stephanie Jones, Suresh Venkatesh, Maudrian Burton, Lucy Brown, Cait Goodall, Matthew Rucklidge, Debbie Fuller, Maria Nadolski, Sandeep Kusre, Michael Lundberg, Lynn Everett, Helen Nutt, Maka Zuleika, Peter Carvalho, Deborah Clements, Ben Creagh-Brown, Philip Watt, Parizade Raymode, Rupert Pearse, Otto Mohr, Ashok Raj, Thais Creary, Ahmed Chishti, Andrea Bell, Charley Higham, Alistair Cain, Sarah Gibb, Stephen Mowat, Danielle Franklin, Claire West, Gary Minto, Nicholas Boyd, Gary Mills, Emily Calton, Rachel Walker, Felicity Mackenzie, Branwen Ellison, Helen Roberts, Moses Chikungwa, Clare Jackson, Andrew Donovan, Jayne Foot, Elizabeth Homan, Jane Montgomery, David Portch, Pauline Mercer, Janet Palmer, Jonathan Paddle, Anna Fouracres, Amanda Datson, Alyson Andrew, Leanne Welch, Alastair Rose, Sandeep Varma, Karen Simeson, Mrutyunjaya Rambhatla, Jaysimha Susarla, Sudhakar Marri, Krishnan Kodaganallur, Ashok Das, Shivarajan Algarsamy, Julie Colley, Simon Davies, Margaret Szewczyk, Thomas Smith, Ana Fernandez-Bustamante, Elizabeth Luzier, Angela Almagro, Marcos Vidal Melo, Luiz Fernando, Demet Sulemanji, Juraj Sprung, Toby Weingarten, Daryl Kor, Federica Scavonetto, Yeo Tze
*Corresponding author for this work
  • Amsterdam UMC - University of Amsterdam
  • Monash University
  • Austin Health
  • University of Melbourne
  • Hospital Israelita Albert Einstein
  • Medical University of Vienna
  • University of Sheffield
  • Massachusetts General Hospital
  • Columbia University
  • University of Bonn
  • University of Insubria
  • Bermannstrost Hospital Halle
  • Martin−Luther−University of Halle−Wittenberg
  • Technische Universität Dresden
  • Cleveland Clinic Foundation
  • Mahidol Oxford Tropical Medicine Research Unit
  • University of Oxford
  • Netherlands Cancer Institute
  • University Hospital Graz
  • Johannes Kepler University Linz
  • Université catholique de Louvain
  • Vrije Universiteit Brussel
  • East Limburg Hospital
  • Ghent University
  • AZ Maria Middelares
  • European Society of Anaesthesiology
  • General Hospital "Prim. Dr. Abdulah Nakas"
  • General Hospital Čakovec
  • General Hospital Karlovac
  • KBC Osijek
  • University Hospital Centre Rijeka
  • Dr. Josip Bencevic General Hospital
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  • Clinical Hospital Merkur
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  • University of Zagreb
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  • North Estonia Medical Centre
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  • Institut Hospitalier Franco-Britannique
  • CHU Montpellier
  • Fachkrankenhaus Coswig
  • Heinrich Heine University Düsseldorf
  • Friederikenstift
  • Leipzig University
  • General Hospital of Athens
  • General Air Force Hospital
  • National and Kapodistrian University of Athens
  • Attikon University Hospital
  • University General Hospital of Thessaloniki "AHEPA"
  • Carmel Medical Center
  • San Paolo Hospital of Bari
  • University of Bari
  • IRCCS Fondazione del Piemonte per l'Oncologia - Candiolo (TO)
  • Azienda Ospedaliera per l'Emergenza Cannizzaro
  • Ospedale di Melegnano
  • Azienda Ospedaliero-Universitaria di Ferrara
  • University of Foggia
  • IRCCS San Martino Polyclinic Hospital
  • San Raffaele Scientific Institute
  • IRCCS Istituto Europeo di Oncologia - Milano
  • Asst Grande Ospedale Metropolitano Niguarda
  • Ospedale San Paolo
  • University of Naples Federico II
  • “Paolo Giaccone” University Hospital
  • University of Parma
  • Santa Maria degli Angeli
  • Ospedale Misericordia e Dolce, Prato
  • University Hospital of Sassari
  • Distric hospital Gjakova
  • University Clinical Center of Kosovo
  • Regional Hospital ”Prim.Dr. Daut Mustafa”
  • Lithuanian University of Health Sciences
  • Vilnius University
  • Mater Dei Hospital
  • University of Amsterdam
  • Amsterdam UMC - Vrije Universiteit Amsterdam
  • Haaglanden MC
  • Westfriesgasthuis
  • University of Bergen
  • Førde Central Hospital /Førde Sentral Sykehus
  • Martina Hansens Hospital
  • Baerum Hospital
  • Stavanger University Hospital
  • Hospital Santo Tomás
  • Hospital do Espírito Santo
  • Central Lisbon University Hospital Center, EPE (CHULC)
  • Hospital São José
  • Hospital Distrital de Santarm
  • Spital Orasenesc Bolintin Vale
  • Clinical Emergency Hospital Bucharest
  • Carol Davila University of Medicine and Pharmacy
  • Emergency Institute of Cardiovascular Diseases Inst.''Prof. C. C. Iliescu''
  • Fundeni Clinical Institute
  • Hospital Profesor D Gerota
  • Constanta County Emergency Hospital
  • Emergency County Hospital Târgu Mureş
  • Krasnoyarsk State Medical University
  • Russian Ministry of Health
  • M.F. Vladimirsky Moscow Regional Research and Clinical Institute
  • Municipal Clinical Hospital
  • Russian Academy of Medical Sciences
  • Emergency Center
  • Slovak Academy of Sciences
  • F.D. Roosevelt Teaching Hospital
  • Faculty Hospital Nové Zámky
  • Institute of Oncology Ljubljana
  • University Medical Centre Ljubljana Department of Neurology
  • Hospital de Sant Pau
  • Generalitat de Catalunya
  • University of Navarra
  • Corporació Sanitària Parc Taulí
  • Hospital General Universitario de Valencia
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  • Kettering General Hospital NHS Trust
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  • The Mid Yorkshire Hospitals NHS Trust
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  • York Teaching Hospital NHS Foundation Trust
  • University of Colorado Anschutz Medical Campus
  • Mayo Clinic Rochester, MN

Research output: Contribution to journalArticleAcademicpeer-review

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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.
Original languageEnglish
Article number111856
JournalJournal of clinical anesthesia
Volume104
DOIs
Publication statusPublished - 1 Jun 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

  1. SDG 3 - Good Health and Well-being
    SDG 3 Good Health and Well-being

Keywords

  • Anaesthesia
  • Intraoperative ventilation
  • PPCs
  • Postoperative outcome
  • Postoperative pulmonary complications
  • Respiratory complications
  • Smoking

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