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SMOKING AND POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG RESECTION: DID SOMETHING CHANGE OVER TIME?

      TOPIC: Tobacco Cessation and Prevention
      TYPE: Original Investigations
      PURPOSE: In the last 20 years, preoperative smoking cessation has been widely accepted as a crucial step in patients preparation before lung surgery in order to reduce postoperative morbidity. Nevertheless, an evident reduction in the number of active smokers at surgery (ASS) has not been demonstrated. The aim of the study was to review a single center cohort of lung cancer patients operated during the last 20 years testing the hypothesis that the number of ASS and subsequently the number of postoperative respiratory complications (PRC) reduced over time.
      METHODS: A cohort of patients who underwent pulmonary resection for lung cancer at the Thoracic Surgery Division of the S.Luigi Hospital, University of Torino, in the period 2001-2021 was reviewed. Data were obtained from the institutional research database. According to their smoking status at the time of surgery, patients were classed as ASS (patients who smoked in the year preceding surgery), ex smokers (having quit smoking at least 12 months before surgery), never smokers. The incidence of postoperative respiratory complications in the first (2001-2011) and second period (2011-2021) of the series were compared.
      RESULTS: From January 2001 to March 2021, 2437 patients were operated and 1053 of them were ASS (43.2%). The rate of PRC was 14% in ASS and 10% in non smokers (ex + never smokers, p 0.009). The rate of ASS increased from the first period (n=463, 34%) to the second period of the study (n= 590, 53%, p 0.0001), as long as the number of never smokers (n=151, 11%, and 200, 18%, respectively). No difference between groups in terms of PRC was detected in the first period (smokers 12%, non smokers 13.5%). During the second period, ASS had an higher risk of PRC as compared to non smokers (16% vs 5%, p 0.0001). The rate of ex-smokers decreased over time from 53.6% (712) in the first decade to 28.8% (321) in the second decade.
      CONCLUSIONS: In our center, protocols of preoperative smoking cessation has to be implemented, as the number of ASS increased over time. Despite the fact that the risk of PRC was increased for ASS in the whole series and in the second decade, surprisingly this effect was not evident in the first decade of the study. In fact, during this period ex smokers had not the expected benefit from smoking cessation. No evidence was found to explain this difference. It can be argued that italian legislation limiting tar content in cigarettes in 2003 could have change pattern of lung damage.
      CLINICAL IMPLICATIONS: The fact that smoke has been recognised as being a major and modifiable risk factor in patients undergoing lung resection does not automatically translates into a significant reduction over time of the number of active smokers at the time of surgery.
      DISCLOSURES: No relevant relationships by Luca Errico, source=Web Response
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