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Determinants of tobacco smoking abstinence one year after major noncardiac surgery: a secondary analysis of the VISION study

August 18, 2022

Background:
Tobacco smoking is a leading preventable cause of death and increases perioperative risk. Determinants of smoking abstinence after noncardiac surgery and the association between smoking and 1-yr vascular outcomes are not fully elucidated.
Methods:
We did a prospective cohort study of 40 004 patients, aged 45 yr, enrolled between August 2007 and November 2013, and followed for 1 yr after surgery. Patients were categorised as never smokers, ex-smokers (quit >4 weeks pre- operatively), and current smokers (smoking 4 weeks preoperatively). Primary outcome was abstinence at 1 yr. Sec- ondary outcome was a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke at 1 yr.
Results:
Of 4658 current smokers, 1838 (39.5%) were abstinent 1 yr after surgery. Median (inter-quartile range) time to resumption was 7 (3e23) days post-surgery. Perioperatively, 7.2% of current smokers obtained smoking cessation pharmacotherapy. Older age (adjusted risk ratio [aRR] 1.21; 95% confidence interval [CI]: 1.12e1.32); having recent cor- onary artery disease (aRR 1.41; 95% CI: 1.29e1.55); cancer (aRR 1.37; 95% CI: 1.18e1.59); and undergoing major vascular (aRR 1.20; 95% CI: 1.02e1.41), urgent/emergent (aRR 1.14; 95% CI: 1.05e1.23), or thoracic (aRR 1.41; 95% CI: 1.26e1.56) surgeries increased abstinence. One-year abstinence was less likely when patients stopped smoking 0e1 day (aRR 0.53; 95% CI: 0.43e0.66) and 2e14 days (aRR 0.76; 95% CI: 0.71e0.82) before surgery compared with >14 days before surgery. Current smokers (adjusted hazard ratio [aHR] 1.14; 95% CI: 1.01e1.29) and ex-smokers (aHR 1.11; 95% CI: 1.03e1.21) had higher risk of the 1-yr vascular outcome compared with never smokers.
Conclusions:
Long-term tobacco abstinence is more likely after major surgery in those with serious medical comor- bidities. Interventions to prevent smoking resumption after surgery remain a priority. Clinical trial registration NCT00512109.
Keywords:
inpatient; noncardiac surgery; pharmacotherapy; smoking cessation; vascular outcomes; VISION study day or night-time surgery; and weekday or weekend surgery) conducted in 28 centres across 14 countries from August 2007 to November 2013.