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A Prospective Study of Tobacco Smoking as a Predictor of Complications in General Surgery

Published online by Cambridge University Press:  02 January 2015

Miguel Delgado-Rodríguez ,
Marcelino Medina-Cuadros ,
Gabriel Martínez-Gallego ,
Antonio Gómez-Ortega ,
Marcial Mariscal-Ortiz ,
Silvia Palma-Pérez  and
María Sillero-Arenas
Miguel Delgado-Rodríguez*
Affiliation:
Division of Preventive Medicine and Public Health, University of Jaén, Jaén, Spain Service of General Surgery, Hospital General Ciudad de Jaén, Jaén, Spain
Marcelino Medina-Cuadros
Affiliation:
Service of General Surgery, Hospital General Ciudad de Jaén, Jaén, Spain
Gabriel Martínez-Gallego
Affiliation:
Service of General Surgery, Hospital General Ciudad de Jaén, Jaén, Spain
Antonio Gómez-Ortega
Affiliation:
Service of General Surgery, Hospital General Ciudad de Jaén, Jaén, Spain
Marcial Mariscal-Ortiz
Affiliation:
Division of Preventive Medicine and Public Health, University of Jaén, Jaén, Spain
Silvia Palma-Pérez
Affiliation:
Division of Preventive Medicine and Public Health, University of Jaén, Jaén, Spain
María Sillero-Arenas
Affiliation:
Service of Health Programs, Provincial Office for Health, Jaén, Spain
*
Division of Preventive Medicine and Public Health, University of Jaén, Building B-3, 23071 Jaén, Spain
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Abstract

Objective:

To analyze whether tobacco smoking is related to nosocomial infection, admission to the intensive care unit, in-hospital death, and length of stay.

Design:

A prospective cohort study.

Setting:

The Service of General Surgery of a tertiary-care hospital.

Patients:

A consecutive series of patients admitted for more than 1 day (N = 2,989).

Results:

Sixty-two (2.1%) patients died and 503 (16.8%) acquired a nosocomial infection, of which 378 (12.6%) were surgical site and 44 (1.5%) were lower respiratory tract. Smoking (mainly past smoking) was associated with a worse health status (eg, longer preoperative stay and higher American Society of Anesthesiologists score). A long history of smoking (≥ 51 pack-years) increased post-operative admission to the intensive care unit (adjusted odds ratio [OR] = 2.86; 95% confidence interval [CI95], 1.21 to 6.77) and in-hospital mortality (adjusted OR = 2.56; CI95, 1.10 to 5.97). There was no relationship between current smoking and surgical-site infection (adjusted OR = 0.99; CI95, 0.72 to 1.35), whereas a relationship was observed between past smoking and surgical-site infection (adjusted OR = 1.46; CI95, 1.02 to 2.09). Current smoking and, to a lesser degree, past smoking augmented the risk of lower respiratory tract infection (adjusted OR = 3.21; CI95, 1.21 to 8.51). Smokers did not undergo additional surgical procedures more frequently during hospitalization. In the multivariate analysis, length of stay was similar for smokers and nonsmokers.

Conclusion:

Smoking increases in-hospital mortality, admission to the intensive care unit, and lower respiratory tract infection, but not surgical-site infection. Deleterious effects of smoking are also observed in past smokers and they cannot be counteracted by hospital cessation programs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 37 - 43
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.McGinnis, JM, Foege, WH. Actual causes of death in the United States. JAMA 1993;270:2207–2212.Google Scholar
2.Bazzino, O, Diaz, R, Tajer, C, et al. Clinical predictors of in-hospital prognosis in unstable angina: ECLA 3. The ECLA Collaborative Group. Am Heart J 1999;137:322–331.CrossRefGoogle ScholarPubMed
3.Hossain, MM, Kotekar, ND, Dhar, VK, Sunny, PF. Clinical epidemiology of acute myocardial iufarction in Shariah, United Arab Emirates. Int J Cardiol 1997;58:77–82.CrossRefGoogle Scholar
4.Klein, HH, Hengstenberg, C, Peuckert, M, Jurgensen, R. Comparison of death rates from acute myocardial infarction in a single hospital in two different periods (1977-1978 versus 1988-1989). Am J Cardiol 1993;71:518–523.Google Scholar
5.Law, SY, Fok, M, Wong, J. Risk analysis in resection of squamous cell carcinoma of the esophagus. World J Surg 1994;18:339–346.CrossRefGoogle ScholarPubMed
6.Whooley, BP, Law, S, Murthy, SC, Alexandrou, A, Wong, J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg 2001;233:338–344.CrossRefGoogle ScholarPubMed
7.Ranger, WR, Glover, JL, Shannon, FL, Sakwa, MP, Bassett, JS. Coronary artery bypass and valve replacement in octogenarians. Am Surg 1996;62:941–946.Google Scholar
8.Moller, AM, Villebro, N, Pedersen, T, Tonnesen, H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002;359:114–117.Google Scholar
9.Folk, JW, Starr, AJ, Early, JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 1999;13:369–372.CrossRefGoogle ScholarPubMed
10.Capen, DA, Calderone, RR, Green, A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am 1996;27:83–86.CrossRefGoogle ScholarPubMed
11.Thalgott, JS, Cotler, HB, Sasso, RC, LaRocca, H, Gardner, V. Postoperative infections in spinal implants. Classification and analysis: a multicenter study. Spine 1991;16:981–984.Google Scholar
12.Camilleri, IG, Malata, CM, Stavrianos, S, McLean, NR. A review of 120 Becker permanent tissue expanders in reconstruction of the breast. Br J Plast Surg 1996;49:346–351.CrossRefGoogle ScholarPubMed
13.Serletti, JM, Davenport, MS, Herrera, HR, Caldwell, EH. Efficacy of prophylactic antibiotics in reduction mammoplasty. Ann Plast Surg 1994;33:476–480.Google Scholar
14.Ridderstolpe, L, Gill, H, Granfeldt, H, Ahlfeldt, H, Rutberg, H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001;20:1168–1175.Google Scholar
15.Hussey, LC, Hynan, L, Leeper, B. Risk factors for sternal wound infection in men versus women. Am J Crit Care 2001;10:112–116.Google Scholar
16.Tennent, TD, Calder, PR, Salisbury, RD, Alen, PW, Eastwood, DM. The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol. Injury 2001;32:491–496.Google Scholar
17.Spelman, DW, Russo, P, Harrington, G, et al. Risk factors for surgical wound infection and bacteraemia following coronary artery bypass surgery. Aust N Z J Surg 2000;70:47–51.CrossRefGoogle ScholarPubMed
18.Gellert, GA, Gordon, SM, Gordon, RS, Strassburg, M, Brenner, WI, Fannin, SL. A cluster of sternal wound infections requiring muscle flap repair: problems in epidemiologic investigation. Am JInfed Control 1991;19:283–289.Google Scholar
19.Vinton, AL, Traverso, LW, Zehring, RD. Immediate breast reconstruction following mastectomy is as safe as mastectomy alone. Arch Surg 1990;125:1303–1307.Google Scholar
20.Goodman, CM, Cohen, V, Armenta, A, Thornby, J, Netscher, DT. Evaluation of results and treatment variables for pressure ulcers in 48 veteran spinal cord-injured patients. Ann Plast Surg 1999;42:665–672.Google Scholar
21.Lavernia, CJ, Sierra, RJ, Gomez-Marin, O. Smoking and joint replacement: resource consumption and short-term outcome. Clin Orthop 1999;367:172–180.Google Scholar
22.Baskett, RJ, MacDougall, CE, Ross, DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg 1999;67:462–465.Google Scholar
23.Izumi, Y, Tsuji, I, Ohkubo, T, Kuwahara, A, Nishino, Y, Hisamichi, S. Impact of smoking habit on medical care use and its costs: a prospective observation of National Health Insurance beneficiaries in Japan. Int J Epidemiol 2001;30:616–621.Google Scholar
24.Haapanen, NN, Miilunpalo, S, Vuori, I, Pasanen, M, Oja, P. The impact of smoking, alcohol consumption, and physical activity on use of hospital services. Am J Public Health 1999;89:691–698.CrossRefGoogle Scholar
25.Canver, CC, Nichols, RD, Kroncke, GM. Influence of age-specific lung function on survival after coronary bypass. Ann Thorac Surg 1998;66:144–147.CrossRefGoogle ScholarPubMed
26.Rocco, MV, Soucie, JM, Reboussin, DM, McClellan, WM. Risk factors for hospital utilization in chronic dialysis patients: Southeastern Kidney Council (Network 6). J Am Soc Nephrol 1996;7:889–896.Google Scholar
27.Baldwin, WA, Rosenfeld, BA, Breslow, MJ, Buchman, TG, Deutschman, CS, Moore, RD. Substance abuse-related admissions to adult intensive care. Chest 1993;103:21–25.CrossRefGoogle ScholarPubMed
28.Chang, SS, Baumgartner, RG, Wells, N, Cookson, MS, Smith, JA Jr. Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol 2002;167:208–211.Google Scholar
29.Tamis, JE, Steinberg, JS. Atrial fibrillation independently prolongs hospital stay after coronary artery bypass surgery. Clin Cardiol 2000;23:155–159.Google Scholar
30.Chung, F, Mezei, G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg 1999;89:1352–1359.CrossRefGoogle ScholarPubMed
31.Jorgensen, HS, Nakayama, H, Raaschou, HO, Olsen, TS. Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants. The Copenhagen Stroke Study. Stroke 1997;28:1138–1141.CrossRefGoogle ScholarPubMed
32.Delgado-Rodríguez, M, Gómez Ortega, A, Sillero Arenas, M, Martinez Gallego, G, Medina Cuadros, M, Llorca, J. Efficacy of surveillance in nosocomial infection control in a surgical service. Am J Infect Control 2001;29:289–294.Google Scholar
33.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206–215.Google Scholar
34.Culver, DH, Horan, RC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S–157S.Google Scholar
35.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
36.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. Centers for Diseases Control (CDC) definitions for nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
37.Rothman, KJ, Greenland, S. Modern Epidemiology, 2nd ed. Boston: Lippincott-Raven; 1997.Google Scholar
38.Dombi, GW, Nandi, P, Saxe, JM, Ledgerwood, AM, Lucas, CE. Prediction of rib fracture injury outcome by an artificial neural network. J Trauma 1995;39:915–921.Google Scholar
39.Hudson, MP, Granger, CB, Topol, EJ, et al. Early reinfarction after fibrinolysis: experience from the global utilization of streptokinase and tissue plasminogen activator (alteplase) for occluded coronary arteries (GUSTO I) and global use of strategies to open occluded coronary arteries (GUSTO III) trials. Circulation 2001;104:1229–1235.Google Scholar
40.Widdershoven, JW, Gorgels, AP, Vermeer, F, et al. Changing characteristics and in-hospital outcome in patients admitted with acute myocardial infarction: observations from 1982 to 1994. Eur Heart J 1997;18:1073–1080.Google Scholar
41.Moller, AM, Maaløe, R, Pedersen, T. Postoperative intensive care admittance: the role of tobacco smoking. Acta Anaesthesiol Scand 2001;45:345–348.CrossRefGoogle ScholarPubMed
42.Kelsey, MC, Mitchell, CA, Griffin, M, Spencer, RC, Emmerson, AM. Prevalence of lower respiratory tract infections in hospitalized patients in the United Kingdom and Eire: results from the Second National Prevalence Survey. J Hosp lnfect 2000;46:12–22.Google Scholar
43.Brooks-Brunn, JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997;111:564–571.Google Scholar
44.Dilworth, JP, White, RJ. Postoperative chest infection after upper abdominal surgery: an important problem for smokers. Respir Med 1992;86:205–210.CrossRefGoogle ScholarPubMed
45.Jones, JK, Triplett, RG. The relationship of cigarette smoking to impaired intraoral wound healing: a review of evidence and implications for patient care. J Oral Maxillofac Surg 1992;50:237–239.Google Scholar
46.Jorgensen, LN, Kallehave, F, Christensen, E, Siana, JE, Gottrup, F. Less collagen production in smokers. Surgery 1998;123:450–455.Google Scholar
47.Bryan, AJ, Lamarra, M, Angelini, GD, West, RR, Breckenridge, IM. Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome. J R Coll Surg Edinb 1992;37:305–308.Google Scholar
48.Paige, KT, Bostwick, J 3rd, Bried, JT, Jones, G. A comparison of morbidity from bilateral, unipedicled and unilateral, unipedicled TRAM flap breast reconstructions. Hast Reconstr Surg 1998;101:1819–1827.CrossRefGoogle ScholarPubMed
49.Lovich, SF, Arnold, PG. The effect of smoking on muscle transposition. Plast Reconstr Surg 1994;93:825–828.Google Scholar
50.Shrotria, S, Webster, DJ, Mansel, RE, Hughes, LE. Complications of rectus abdominis myocutaneous flaps in breast surgery. Eur J Surg Oncol 1993;19:80–83.Google Scholar
51.Haughey, BH, Wilson, E, Kluwe, L, et al. Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 2001;125:10–17.Google Scholar
52.Vinton, AL, Traverso, LW, Jolly, PC. Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection. Am J Surg 1991;161:584–588.CrossRefGoogle ScholarPubMed
53.Prendiville, EJ, Yeager, A, O'Donnell, TF Jr, et al. Long-term results with the above-knee popliteal expanded polytetrafluoroethylene graft. J Vase Surg 1990;11:517–524.Google Scholar
54.Goldaber, KG, Wendel, PJ, Mclntire, DD, Wendel, GD Jr. Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol 1993;168:489–493.Google Scholar
55.Cheynet, F, Chossegros, C, Richard, O, Ferrara, JJ, Blanc, JL. Complications infectieuses des osteotomies mandibulaires. Rev Stomatol Chir Maxillofac 2001;102:26–33.Google Scholar
56.Beitsch, P, Batch, C. Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection. Am J Surg 1992;164:462–465.Google Scholar
57.Kamat, AA, Brancazio, L, Gibson, M. Wound infection in gynecologic surgery. Infect Dis Obstet Gynecol 2000;8:230–234.Google Scholar
58.Nicolle, LE, Huchcroft, SA, Cruse, PJ. Risk factors for surgical wound infection among the elderly. J Clin Epidemiol 1992;45:357–364.Google Scholar
59.Terracciano, CA, Iannuzzi, C, Maione, P, Ardero, G, Gallo, C. Identificazione del paziente a rischio di complicanze settiche post-operatorie: fattori di rischio e loro valutazione. Ann Ital Chir 1992;63:141–145.Google Scholar
60.Robbins, KT, Favrot, S, Hanna, D, Cole, R. Risk of wound infection in patients with head and neck cancer. Head Neck 1990;12:143–148.CrossRefGoogle ScholarPubMed
61.Christakis, GT, Fremes, SE, Naylor, CD, Chen, E, Rao, V, Goldman, BS. Impact of preoperative risk and perioperative morbidity on ICU stay following coronary bypass surgery. Cardiovasc Surg 1996;4:29–35.Google Scholar