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

Sandra N Ofori; Maura Marcucci; Lawrence Mbuagbaw; David Conen; Flavia K Borges; Clara K Chow; Daniel I Sessler; Matthew T V Chan; Graham S Hillis; Shirley Pettit; Diane Heels-Ansdell; Philip J Devereaux; Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study Investigators

doi:10.1016/j.bja.2022.07.010

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

Br J Anaesth. 2022 Oct;129(4):497-505. doi: 10.1016/j.bja.2022.07.010. Epub 2022 Aug 18.

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada. Electronic address: oforis@mcmaster.ca.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada.
⁴ Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia.
⁶ Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
⁷ Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
⁸ George Institute for Global Health, University of Sydney, Sydney, Australia; Royal Perth Hospital, Perth, Australia; University of Western Australia, Perth, Australia.
⁹ Population Health Research Institute, Hamilton, ON, Canada.
¹⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 35987704
DOI: 10.1016/j.bja.2022.07.010

Abstract

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 preoperatively), and current smokers (smoking ≤4 weeks preoperatively). Primary outcome was abstinence at 1 yr. Secondary 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 (3-23) 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]: 1.12-1.32); having recent coronary artery disease (aRR 1.41; 95% CI: 1.29-1.55); cancer (aRR 1.37; 95% CI: 1.18-1.59); and undergoing major vascular (aRR 1.20; 95% CI: 1.02-1.41), urgent/emergent (aRR 1.14; 95% CI: 1.05-1.23), or thoracic (aRR 1.41; 95% CI: 1.26-1.56) surgeries increased abstinence. One-year abstinence was less likely when patients stopped smoking 0-1 day (aRR 0.53; 95% CI: 0.43-0.66) and 2-14 days (aRR 0.76; 95% CI: 0.71-0.82) before surgery compared with >14 days before surgery. Current smokers (adjusted hazard ratio [aHR] 1.14; 95% CI: 1.01-1.29) and ex-smokers (aHR 1.11; 95% CI: 1.03-1.21) 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 comorbidities. Interventions to prevent smoking resumption after surgery remain a priority. Clinical trial registration NCT00512109.

Keywords: VISION study; inpatient; noncardiac surgery; pharmacotherapy; smoking cessation; vascular outcomes.

Publication types

Clinical Study

MeSH terms

Humans
Middle Aged
Postoperative Period
Prospective Studies
Smoking Cessation* / statistics & numerical data
Tobacco Smoking* / epidemiology
Tobacco Smoking* / prevention & control

Associated data

ClinicalTrials.gov/NCT00512109