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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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