Risk Stratification of Smokers Undergoing Colorectal Surgery.

Area of Science:

• Surgical Outcomes Research
• Tobacco Use and Health
• Colorectal Surgery

Background:

• Smoking is a known risk factor for postoperative complications.
• Limited data exists on how specific smoking characteristics beyond pack-years influence surgical risk.
• Understanding these factors is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To evaluate the impact of preoperative smoking duration, intensity, cessation periods, and smokeless product use on colorectal surgery outcomes.
• To identify specific smoking-related factors that predict major adverse events postoperatively.

Main Methods:

• Retrospective cohort study of 239 current and former smokers undergoing colorectal surgery (2012-2022).
• Data collected on demographics, smoking habits (duration, intensity, cessation, smokeless products), and operative details.
• Primary endpoint: major adverse events within 30 days (e.g., bleeding, VTE, AKI, MI, ARDS, stroke, infection, mortality, readmission).

Main Results:

• 28% of patients experienced major adverse events within 30 days.
• Independent predictors of increased complications included chronic obstructive pulmonary disease (COPD), pack-years, and concurrent vape use.
• Longer smoking duration was a significant predictor, while packs-per-day was not; former smokers had fewer complications than current smokers.

Conclusions:

• Preoperative smoking duration and concurrent vape use are significant independent predictors of major postoperative complications in colorectal surgery.
• Patients with extensive smoking histories or concurrent vaping should receive thorough counseling on their elevated risks.
• Cessation of smoking prior to surgery is associated with reduced complication rates.