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Journal of Cardiothoracic Surgery

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Open Access 01-12-2015 | Research article

Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery

Authors: Qiang Ji, Hang Zhao, YunQing Mei, YunQing Shi, RunHua Ma, WenJun Ding

Published in: Journal of Cardiothoracic Surgery | Issue 1/2015

Abstract

Background

To evaluate the impact of persistent smoking versus smoking cessation over one month prior to surgery on early clinical outcomes in Chinese patients undergoing isolated coronary artery bypass grafting (CABG) surgery in a retrospective study.

Methods

The peri-operative data of consecutive well-documented patients undergoing isolated CABG surgery from January 2007 to December 2013 were investigated and retrospectively analyzed. All included patients were divided into either a non-smoking group or a smoking group according to preoperative smoking records. Furthermore, smokers were divided into either a former smoking subgroup (smokers with smoking cessation over 1 month before surgery) or a current smoking subgroup (persistent smokers).

Results

A total of 3730 consecutive patients (3207 male patients and mean 63.6 ± 9.5 years) undergoing isolated CABG surgery were analyzed. Persistent smokers had significantly higher incidence of postoperative pulmonary complications as compared to non-smokers (7.8% vs. 4.5%, p = 0.0002). No significantly differences in both surgical mortality and major postoperative morbidities between smokers with smoking cessation over 1 month before surgery and non-smokers were found. In multiple logistic regression analysis, the risk of postoperative pulmonary complications in persistent smokers was 2.41 times than that in non-smokers, whereas the risk of postoperative pulmonary complications in smokers with smoking cessation over 1 month before surgery was similar to non-smokers.

Conclusions

Persistent smokers had a higher incidence of pulmonary complications following CABG as compared to non-smokers. Smoking cessation more than 1 month before surgery was expected to reduce early major morbidities following CABG surgery.

Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.CrossRefPubMed

Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc. 1989;64:609–16.CrossRefPubMed

Sepehripour AH, Lo TT, McCormack DJ, Shipolini AR. Is there benefit in smoking cessation prior to cardiac surgery? Interact Cardiovasc Thorac Surg. 2012;15:726–32.CrossRefPubMedPubMedCentral

Gu D, Kelly TN, Wu X, Chen J, Samet JM, Huang JF, et al. Mortality attributable to smoking in China. N Engl J Med. 2009;360:150–9.CrossRefPubMed

Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1:219–27.PubMed

Arozullah AM, Henderson WG, Khuri SF, Daley J. Postoperative mortality and pulmonary complication rankings: how well do they correlate at the hospital level? Med care. 2003;41:979–91.CrossRefPubMed

Carrier M, Pellerin M, Perrault LP, Solymoss BC, Pelletier LC. Troponin levels in patients with myocardial infarction after coronary artery bypass grafting. Ann Thorac Surg. 2000;69:435–40.CrossRefPubMed

Sa MP, Nogueira JR, Ferraz PE, Figueiredo OJ, Cavalcante WC, Cavalcante TC, et al. Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc. 2012;27:217–23.CrossRefPubMed

Sachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surg Clin North Am. 2012;92:321–44.CrossRefPubMed

10.

Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, et al. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140:1207–15.CrossRefPubMed

11.

Antunes PE, Prieto D, Ferrao de Oliveira J, Antunes MJ. Renal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg. 2004;25:597–604.CrossRefPubMed

12.

Swenne CL, Lindholm C, Borowiec J, Carlsson M. Surgical-site infections within 60 days of coronary artery bypass graft surgery. J Hosp Infect. 2004;57:14–24.CrossRefPubMed

13.

Calandra T, Cohen J. International Sepsis Forum Definition of Infection in the ICUCC. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33:1538–48.CrossRefPubMed

14.

Van Domburg RT, op Reimer WS, Hoeks SE, Kappetein AP, Bogers AJ. Three life-years gained from smoking cessation after coronary artery bypass surgery: a 30-year follow-up study. Am Heart J. 2008;156:473–6.CrossRefPubMed

15.

Benedetto U, Albanese A, Kattach H, Ruggiero D, De Robertis F, Amrani M, et al. Harefield Cardiac Outcomes Research Group. Smoking cessation before coronary artery bypass grafting improves operative outcomes. J Thorac Cardiovasc Surg. 2014;148:468–74.CrossRefPubMed

16.

Saxena A, Shan L, Reid C, Dinh DT, Smith JA, Shardey GC, et al. Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery. J Cardiol. 2013;61:336–41.CrossRefPubMed

17.

Papathanasiou A, Milionis H, Toumpoulis I, Kalantzi K, Katsouras C, Pappas K, et al. Smoking cessation is associated with reduced long-term mortality and the need for repeat interventions after coronary artery bypassgrafting. Eur J Cardiovasc Prev Rehabil. 2007;14:448–50.CrossRefPubMed

18.

Smith PM, Burgess E. Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial. CMAJ. 2009;180:1297–303.CrossRefPubMedPubMedCentral

19.

He Y, Lam TH, Jiang B, Wang J, Sai X, Fan L, et al. Combined effects of tobacco smoke exposure and metabolic syndrome on cardiovascular risk in older residents of China. J Am Coll Cardiol. 2009;53:363–71.CrossRefPubMed

20.

Al-Sarraf N, Thalib L, Hughes A, Tolan M, Young V, McGovern E. Effect of smoking on short-term outcome of patients undergoing coronary artery bypass surgery. Ann Thorac Surg. 2008;86:517–23.CrossRefPubMed

Title: Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery
Authors: Qiang Ji
Hang Zhao
YunQing Mei
YunQing Shi
RunHua Ma
WenJun Ding
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2015
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-015-0216-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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