Smoking Increases Risk for Complications after Colorectal Surgery

Douglas K. Rex, MD

Clinicians should use this opportunity to encourage smoking cessation in patients who will likely need such surgery.

Previous studies have demonstrated an association between cigarette smoking and increased risk for infectious complications, anastomotic leaks, strictures, and overall complications after colorectal surgery. Now, using data from the American College of Surgeons National Surgical Quality Improvement Program (2005–2010) database, researchers examined whether cigarette smoking was associated with risk for morbidity or mortality 30 days after colorectal surgery for cancer (26,333 patients), diverticular disease (14,019) or inflammatory bowel disease (7222).

All patients were categorized as never-smokers, ex-smokers, or current smokers. Results were as follows:

In univariate analyses:

• Current smokers had the highest rates of infectious complications, pneumonia, return to the operating room, and incisional infection.
•  Former smokers had the highest rates of ventilator dependency, cardiac complications, renal complications, and 30-day mortality.
• In multivariate analyses:
•  Current smokers were at elevated risk for incisional infection, infectious complication, and major complication (adjusted odds ratio, 1.3 for each) and mortality (adjusted OR, 1.5) in the 30 days after surgery for either benign or malignant disease.
• Results were similar in subanalyses of patients with Crohn disease and of patients without comorbidities.
• A dose-dependent relationship was observed between amount of smoking and mortality: Patients in the highest use category (≥60 pack-years) had the highest mortality risk (adjusted OR, 1.85).

Citation(s):

Sharma A et al. Tobacco smoking and postoperative outcomes after colorectal surgery. Ann Surg 2013 Aug; 258:296.