Relationship of smoking with respiratory complications in surgical patients

doi:10.21203/rs.3.rs-5178286/v1

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Relationship of smoking with respiratory complications in surgical patients

https://doi.org/10.21203/rs.3.rs-5178286/v1

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Objective: The aim of this study was to investigate the relationship between the occurrence of postoperative respiratory complications and smoking.

Methods and Materials: A retrospective study was conducted on 100 cases who underwent surgical procedures in the General Surgery Department between 2023 and 2024. The SPSS program was used for statistical analysis.

Results: The percentage of males was 49%, while females were 51%. The average age of the patients was 48.37 ± 16.67 years. Of the patients, 50% were smokers and 50% were non-smokers. The average number of packs consumed by smokers was 36.54 ± 38.12 packs/year. A total of 3 cases of complications occurred among smokers and 2 cases among non-smokers. The complications included oxygen desaturation, excessive sputum production, postoperative respiratory infection, pleural effusion, pulmonary embolism, cough, bronchospasm, and the average hospital stay duration after the complication was 3.1 ± 0.74 days.

Conclusion: A positive correlation was found between smoking and postoperative complications (P<0.05). Our results indicate that the amount of cigarettes consumed is associated with the rate of postoperative complications.

Pulmonology

General surgery

respiratory complications

smoking.

The impact of smoking on health is well-documented, with numerous studies highlighting its harmful effects on various body systems. One area that has garnered significant attention is the relationship between smoking and surgical outcomes. Given that surgical procedures inherently involve trauma to the body, the physiological consequences of smoking can significantly affect recovery and the overall prognosis of the patient. By examining existing literature and clinical data, this research will elucidate the mechanisms by which smoking negatively influences surgical recovery and provide insights for improving patient care protocols.

Study Design:

The study was planned as a retrospective prospective study and was approved by the local ethics committee at Damascus Hospital. A total of 150 adult patients aged between 14 and 78 years, classified as ASA I and II by the American Society of Anesthesiologists (ASA), who received general anesthesia, spinal anesthesia, or local anesthesia for various elective surgical procedures between March 1, 2023, and March 1, 2024, were included in the study.

Exclusion Criteria:

Patients classified as ASA III and IV, those with chronic respiratory diseases, those with acute upper or lower respiratory tract infections within two weeks prior to surgery, patients with severe systemic diseases, and smokers who quit smoking within five years before the study were excluded. Twenty patients who were found to have upper respiratory tract infections in the preoperative period were also excluded from the study.

Patient Groups:

The remaining 100 patients were divided into the study group and the control group. Fifty patients were active smokers in the study group, and fifty patients were non-smokers in the control group.

Procedure:

An intravenous catheter was inserted, and 2 mg of midazolam was administered before transferring the patient to the operating room. Electrocardiography, blood pressure measurement, peripheral oxygen saturation, and capnography were monitored in the operating room. The anesthesia method was determined by the primary anesthesiologist of the patient. Airway management was controlled using a face mask, mask, laryngeal mask, or endotracheal intubation depending on the surgical procedure.

General anesthesia was induced using 2-2.5 mg/kg propofol, 1 µg/kg remifentanil, and 0.1 mg/kg vecuronium for intubation. After intubation, mechanical ventilation parameters were set to 50% oxygen-air with an inspired oxygen concentration of 50%. Anesthesia was maintained using 1-2% sevoflurane, remifentanil infusion at 0.05 µg/kg, and vecuronium injection. Each patient received 1 gram of paracetamol intravenously over 15 minutes for postoperative pain relief as the surgery was nearing completion. Spinal anesthesia was administered by injecting 15 to 25 ml of preservative-free 2% or 3% chloroprocaine solution, with additional doses administered every 40 to 50 minutes as needed.

At the end of the procedure, the endotracheal tube was removed from all intubated patients, and a study was conducted to assess whether complications such as bronchospasm, laryngospasm, oxygen desaturation, excessive sputum production, cough, atelectasis, pulmonary embolism, and pleural effusion occurred. If more than one of these complications appeared, all were taken into account. The need for mechanical ventilation and intensive care was also evaluated.

Statistical Analysis:

Statistical analysis was performed using the SPSS software (Statistical Package for the Social Sciences) version 26, in the Biostatistics Department of the Syrian Private University Faculty of Medicine. The Mann-Whitney U test was used to compare differences between groups for non-normally distributed variables and to identify the group contributing to these differences. The Chi-square test and Fisher’s Exact Chi-square test were used to compare qualitative variables, and the Independent T-test was used to compare quantitative statistical differences. The results were evaluated at a 95% confidence interval, with a P-value of <0.05 considered statistically significant.

Demographic Information:

The study sample consisted of 100 patients after considering the exclusion and inclusion criteria. The average age of the patients was 48.37 years, with a standard deviation of 16.67 years, and the age range was between 14 and 78 years. The proportion of male patients was 49%, while the proportion of female patients was 51%.

Smoking Status and Quantity Among Patients:

The study patients were divided into two groups: 50 smokers (50%) and 50 non-smokers (50%). The average smoking duration among the smokers was 36.54 pack-years, with a standard deviation of 38.12 pack-years, and the values ranged from 2 pack-years to 150 pack-years.

Type of Anesthesia Used During the Surgery:

Most of the patients, 73%, underwent general anesthesia, 25% received spinal anesthesia, and 2% had local anesthesia.

Type of Surgery Performed on Patients:

The most common surgeries performed were cholecystectomy, hernia repair, and amputation, with frequencies of 24%, 14%, and 9%, respectively. The average duration of the surgeries was 106 minutes, with a standard deviation of 62.07 minutes, ranging from 20 minutes to 330 minutes.

Incidence, Timing, and Type of Respiratory Complications:

The incidence of respiratory complications among the study patients was 5%, and all complications occurred postoperatively. The most common complications were oxygen desaturation, excessive sputum production, postoperative respiratory infection, and pleural effusion, each accounting for 40% of the total complications. Pulmonary embolism, cough, and bronchospasm each accounted for 20% of the total complications. The average hospital stay for patients who experienced complications was 3.1 days, with a standard deviation of 0.74 days.

Need for Mechanical Ventilation and Intensive Care:

The percentage of patients who required intensive care was 19%, while 1% of the patients needed mechanical ventilation and remained on the ventilator for 3 days.

Relationship Between Smoking and the Occurrence of Respiratory Complications:

It was observed that the rate of complications was higher among smokers compared to non-smokers, with a statistically significant difference (p = 0.002).

Relationship Between the Type of Respiratory Complications and Smoking:

All respiratory complications occurred in smokers except for oxygen desaturation and excessive sputum production, which occurred equally among both smokers and non-smokers.

Comparison of Smoking Quantity Based on the Presence or Absence of Respiratory Complications:

The amount of smoking was higher among patients who experienced postoperative respiratory complications, with a statistically significant difference.

Comparison of Smoking Quantity Based on the Type of Respiratory Complications:

We found that the average amount of smoking was higher among patients who experienced oxygen desaturation, pleural effusion, pulmonary embolism, cough, bronchospasm, and postoperative respiratory infection.

Relationship Between Smoking Quantity and the Need for Intensive Care:

We found that the amount of smoking was higher among patients who required intensive care after surgery, with a statistically significant difference.

In our study, we investigated the relationship between smoking and postoperative complications in patients undergoing surgery under general or spinal anesthesia.

Currently, smoking is one of the most discussed topics due to its medical consequences and legal and social aspects. Prolonged smoking leads to changes in the airways, which can cause various perioperative complications. In these patients, postoperative complications such as coughing, bronchospasm, laryngospasm, decreased oxygen saturation, and increased secretions were more frequent in the smoking group compared to the non-smoking group {1}.

In our study, the complication rate was 5%, with 40% of these patients experiencing oxygen desaturation, 40% having excessive sputum production, 40% developing postoperative respiratory infections, and 40% experiencing pleural effusion. Pulmonary embolism, cough, and bronchospasm each accounted for 20% of the complications. One study reported that the rate of respiratory complications was 86.2% in the smoking group and 13.8% in the non-smoking group, while in our study, the rates were 60% in the smoking group and 40% in the non-smoking group.

Another study involving 9,297 cases indicated that smoking was a risk factor for increased postoperative respiratory complications. However, in a study evaluating COHB, PaO2, and PaCO2 levels during anesthesia and postoperative complications in 150 patients, no significant differences were found between smokers and non-smokers {2}.

In our study, we found that the rate of respiratory complications increased with the amount of smoking (P < 0.05).

Some studies have shown that smokers had an increased incidence of postoperative respiratory complications, and others have reported that complications are more likely in the postoperative period {3}. In our study, we did not find any intraoperative complications in either group; most complications occurred postoperatively, and our results are consistent with other studies. Smokers are significantly more prone to complications during and after surgery. Furthermore, with increased smoking quantity, the rate of postoperative complications also increases.

Many studies conducted on smoking patients have shown an increase in the incidence of bronchospasm during surgery, and the risk of developing bronchospasm increases with the amount of smoking. One study revealed that the incidence of bronchospasm increases by 4.9 times in smokers.

Postoperative respiratory complications such as coughing and oxygen desaturation have been reported more frequently in smoking patients{4}. This result is consistent with our findings, where coughing and oxygen desaturation increased with the amount of smoking (P < 0.05).

Smoking causes dysplasia of goblet cells in the respiratory system and excessive mucus production in the bronchi and small airways. The accumulated secretions during surgery can lead to hypersecretion issues and oxygen desaturation, especially during and after the surgical procedure. The incidence of these complications increases with the amount of smoking, as reported by other studies {5}.

In our study, we found that the average smoking quantity was higher in those who required intensive care (P < 0.05). We suggest that the increased incidence of postoperative complications in these patients plays a significant role in prolonging recovery time or increasing the likelihood of requiring intensive care.

There are also many studies that suggest the need for intensive care after surgery may increase with higher levels of smoking exposure{6}.

One study reported prolonged stays in the intensive care unit after surgery for smoking patients, but they did not find any significant results{7}.

Ethics approval and consent to participate

The study protocol was approved by the Research Ethics Committee of Syrian Private University and the relevant ethics committees of Syrian Private University, and all procedures performed in the studies involving the participant and subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent for publication

Not applicable.

Availability of data and materials

All data produced in the present work are contained in the manuscript

Convict of interest

The authors declare that they have no convict of interest.

Funding

This research received no speciﬁc grant from SPU or any other funding agency in the public, commercial or non-profit.

Acknowledgments

We are thankful to the management of Syrian Private University and Damascus Hospital for their support in the eld of medical training and research.

Seyidov TH, Elemen L, Solak M, et al. Passive smoke exposure is associated with perioperative adverse effects in children. J Clin Anesth. 2011; 23:47-52. 4. Rodrigo C. The effects of cigarette smoking on anesthesia. Anesth Prog. 2001; 47:143-50.
Skolnick ET, Vomvolakis MA, Buck KA, et al. Exposure to envi- ronmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. Anesthesiology. 1998:88:1144.
Mamie C, Habre W, Delhumeau C, et al. Incidence and risk factors of perioperative respiratory adverse events in chil- dren undergoing elective surgery. Paediatr Anaesth. 2004;14: 218-24.
Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospec- tive cohort study. Lancet. 2010; 376:773-83.
Tütüncü A, Dilmen O, Utku T, et al. The effects of passive smoking on COHb, PaO2 and PaCO2 levels and postoperative respiratory complications in children undergoing general anes- thesia Turk. Arch Ped. 2012; 47:204-9.
Boyaci H, Etiler N, Duman C, et al. Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures. Pediatr Int. 2006; 48:382-9.
Jones DT, Bhattacharyya N. Passive smoke exposure as a risk factor for airway complications during outpatient pedi- atric procedures. Otolaryngol Head Neck Surg. 2006;135; 12-6.

The authors declare no competing interests.

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Relationship of smoking with respiratory complications in surgical patients

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Abstract

Introduction

Methods and materials

Results

Discussion

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References

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