Introduction Smoking is a risk factor for postoperative pulmonary complications (PPCs) following curative-intent surgery for lung cancer. Risk modification is via smoking cessation; the role that electronic cigarettes (e-cigarettes) have in preoperative tobacco replacement is a debated topic.
Aims Investigate the impact of smoking on postoperative outcome including long-term survival. Assess current smoking habits and attitudes towards preoperative smoking cessation, with emphasis on e-cigarette use.
Methods A prospective observational study was carried out on all patients following curative-intent lung cancer resection in a regional thoracic centre over 4 years. Preoperative smoking status was self-reported by all patients. PPCs were assessed daily in hospital using the Melbourne group scale.1 Other data included patient demographics, hospital length of stay (LOS), intensive treatment unit (ITU) admission and mortality data. To assess smoking habits, a questionnaire was given to 105 patients attending the preoperative assessment unit.
Results Of 460 patients, 24% were current smokers, 12% ex-smokers 6 weeks duration, and 11% never smoked Compared to never smokers, current smokers had significantly longer hospital LOS in days (9, CI 7–11 vs. 6, CI 4–8; p < 0.001), higher frequency of PPCs (22% vs 2%, p = 0.001) and ITU admissions (14% vs. 0%; p < 0.005). Compared to never smokers, the trend was for reduced survival in current smokers from 1–3 years, but the survival lines converged after this (median follow-up 30 vs. 31 months; p = 0.31). The questionnaire found 24/105 patients were smokers, of these 80% patients had previously tried to quit but only 38% had been specifically approached by health-care professionals about smoking cessation. When asked if they would consider stopping smoking immediately if supplied an e-cigarette, 54% said yes.
Conclusions Preoperatively, 1 in 4 patients continue to smoke; the majority have attempted to quit and failed. Current smokers have higher postoperative morbidity with no significant survival difference within our follow-up period. Current methods of preoperative smoking cessation in this population are ineffective; patients appear willing to use e-cigarettes. Further research in this field is urgently needed.
Reference 1 Agostini P, et al. Thorax 2010;65:815–18