Dorland Galina, Saadat W, van Meenen David M P, Neto Ary Serpa, Hiesmayr Michael, Hollmann Markus W, Mills Gary H, Vidal Melo Marcos F, Putensen Christian, Schmid Werner, Severgnini Paolo, Wrigge Hermann, de Abreu Marcelo Gama, Schultz Marcus J, Hemmes Sabrine N T
Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
J Clin Anesth. 2025 Jun;104:111856. doi: 10.1016/j.jclinane.2025.111856. Epub 2025 May 14.
While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting.
We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs).
Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in-hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes.
Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non-smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non-smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings.
The occurrence of PPCs in smokers is not different from non-smokers.
This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands.
LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223).
Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.
虽然吸烟一直被认为是术后并发症的一个重要促成因素，但关于其与术后肺部并发症关联的现有文献仍存在矛盾之处。
我们研究了术前吸烟与术后肺部并发症（PPCs）发生之间的关联。
对一项在29个国家的146家医院开展的观察性研究进行事后分析。根据加泰罗尼亚外科患者呼吸风险评估（ARISCAT）评分（≥26分），我们纳入了发生PPCs风险增加的患者。主要终点是术后头五天内出现一种或多种预先定义的PPCs，包括术后意外需要补充氧气、呼吸衰竭、意外需要有创通气、急性呼吸窘迫综合征（ARDS）、肺炎和气胸。次要终点包括住院时间和院内死亡率。我们进行了倾向评分匹配，以校正与术后结局有已知关联的因素。
在2632例患者中，531例（20.2%）为吸烟者，2102例（79.8%）为非吸烟者。术后五天时，101例（19.0%）吸烟者与404例（19.2%）非吸烟者出现了一种或多种PPCs（P = 0.95）。呼吸衰竭在吸烟者（5.1%）中比非吸烟者（3.0%）中更常见（P = 0.02），而其他PPCs如需要补充氧气、有创通气、ARDS、肺炎或气胸的发生率在两组之间没有差异。两组之间的住院时间和死亡率没有差异。倾向评分匹配并未改变研究结果。
吸烟者中PPCs的发生率与非吸烟者没有差异。
本分析未获得额外资金支持。LAS VEGAS部分由欧洲麻醉学会通过其临床试验网络以及荷兰阿姆斯特丹大学医学中心提供资金并予以认可。
LAS VEGAS在Clinicaltrials.gov（NCT01601223）注册。
初步研究结果已在德国慕尼黑举行的2024年欧洲麻醉学国际大会上公布。
