Risk Stratification of Smokers Undergoing Colorectal Surgery

Abstract

Background

Smoking is an established risk factor for postoperative complications. There is limited data on characteristics of smokers that increase risk beyond pack-years. This study aims to assess the effect of preoperative smoking duration and intensity, periods of cessation, and concurrent smokeless product use on colorectal surgery outcomes.

Methods

A retrospective cohort study was conducted to assess operative details, demographic and smoking factors, and postoperative complications in smokers. The cohort included 239 current and former smokers who underwent colorectal surgery from 2012 to 2022. The primary endpoint was major adverse events 30-days postoperatively, defined as incidence of major bleeding, venous-thromboembolism, acute kidney injury, myocardial infarction, acute respiratory distress syndrome, stroke, infection, mortality, or readmission.

Results

The most common procedure was colon resection. Average age at procedure was 63.9 ± 0.85 years, smoking duration was 27.0 ± 1.0 years, packs-per-day was 0.94 ± 0.04 packs, and pack-years was 26.0 ± 1.7. It was found that 11% of the patients concurrently used smokeless products (chew, dip, and/or vape). Half of the patients quit smoking prior to surgery. During the follow-up period, 28% had any major adverse event. Independent predictors of increased complications were chronic obstructive pulmonary disease (P = .01), pack-years (P = .02), and concurrent vape use (P = .01). Years of smoking (P = .01) was an independent predictor of complications, whereas packs-per-day (P = .33) was not. Former smokers (P = .03) had fewer complications than current smokers.

Discussion

Colorectal surgery patients with significant duration of smoking and/or concurrent vape use should be counseled regarding their increased risk of major postoperative complications.