328. Effect of Timing of Smoking Cessation on Postoperative Outcomes in Lobectomy Patients
Emily A. Kragel, Carlos J. Anciano, Aundrea L. Oliver, *Mark D. Iannettoni, James E. Speicher
East Carolina University, Greenville, NC
Invited Discussant: *Betty C. Tong
Objective: To evaluate whether timing of smoking cessation impacts postoperative outcomes in patients undergoing surgical lobectomy.
Methods: An IRB-approved, single-institution, retrospective chart review was performed of patients undergoing lobectomy (N=188) between 2014 and 2017. Baseline variables, smoking history, surgical procedure, surgical pathology findings, and postoperative outcomes were collected. Data analysis included descriptive statistics and binary logistic regression to identify predictive factors for postoperative outcomes (length of stay, chest tube duration, air leak duration, complications, 30-day readmission, 30- and 60-day mortality). Pulmonary complications included atelectasis, suspected pulmonary infection (raised WBC, antibiotic use, fever with positive sputum culture), low O2 saturation on room air, diagnosed pulmonary infection, subcutaneous emphysema, lung collapse, greater than expected pneumothorax, and respiratory failure.
Results: Approximately 92% (173/188) of patients had a history of smoking and almost 50% (79/173) of these patients were current smokers (smoking history within 4 months of surgery). Post-operative outcomes based on smoking cessation duration are reported in Table 1. Increased duration of smoking cessation prior to surgery was found to be significantly associated with a decreased risk of pulmonary complications, χ2 =6.250, p=0.012. Compared to patients with no smoking history, smoking within 2 weeks of surgery (OR=9.8, p=0.017) and between 2 weeks and 1 month before surgery (OR= 7.0, p=0.0176) significantly increased risk of pulmonary complications, Smoking between 1 and 2 months before surgery did not significantly increase the risk of pulmonary complications (OR=2.45, p=0.305), when compared to patients with no smoking history. Other baseline variables, including gender, age, BMI, and FEV1/DLCO %predicted, and type of surgical procedure (thoracoscopy vs. thoracotomy) were not significantly associated with pulmonary complications.
Conclusions: The large percentage of current smokers in this patient population sheds light on the importance of investigating and improving smoking cessation methods prior to lobectomy. The results of this study indicate that earlier smoking cessation dates of at least four weeks prior to surgery should be encouraged when possible.
<2 weeks, N=12
2-4 weeks, N=40
>4 weeks, N=27
All patients, N=188
Mean length hospital stay (days)
Mean chest tube duration (days)
Mean air leak duration (days)
% Pulmonary complications
% Other complications
% 30-day readmission
% 30-day mortality
% 60-day mortality