TY - JOUR
T1 - Smoking cessation reduces postoperative complications
T2 - A systematic review and meta-analysis
AU - Mills, Edward
AU - Eyawo, Oghenowede
AU - Lockhart, Ian
AU - Kelly, Steven
AU - Wu, Ping
AU - Ebbert, Jon O.
N1 - Funding Information:
Funding: Development of this manuscript was sponsored by Pfizer Ltd , Walton Oaks, Walton-On-The-Hill, Surrey, KT20 7NS, United Kingdom. Edward Mills, Oghenowede Eyawo, and Ping Wu were paid consultants to Pfizer in connection with the development of this manuscript. Jon Ebbert received no compensation. Edward Mills is supported by a Canada Research Chair .
PY - 2011/2
Y1 - 2011/2
N2 - Objective We aimed to review randomized trials and observational evidence to establish the effect of preoperative smoking cessation on postoperative complications and to determine if there is an optimal cessation period before surgery. Methods We conducted a systematic review of all randomized trials evaluating the effect of smoking cessation on postoperative complications and all observational studies evaluating the risk of complications among past smokers compared with current smokers. We searched independently, in duplicate, 10 electronic databases and the bibliographies of relevant reviews. We conducted a meta-analysis of randomized trials using a random effects model and performed a meta-regression to examine the impact of time, in weeks, on the magnitude of effect. For observational studies, we pooled proportions of past smokers in comparison with current smokers. Results We included 6 randomized trials and 15 observational studies. We pooled the 6 randomized trials and demonstrated a relative risk reduction of 41% (95% confidence interval [CI], 15-59, P = .01) for prevention of postoperative complications. We found that each week of cessation increases the magnitude of effect by 19%. Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04). Observational studies demonstrated important effects of smoking cessation on decreasing total complications (relative risk [RR] 0.76, 95% CI, 0.69-0.84, P < .0001, I 2 = 15%). This also was observed for reduced wound healing complications (RR 0.73, 95% CI, 0.61-0.87, P = .0006, I 2 = 0%) and pulmonary complications (RR 0.81, 95% CI, 0.70-0.93, P = .003, I 2 = 7%). Observational studies examining duration of cessation demonstrated that longer periods of cessation, compared with shorter periods, had an average reduction in total complications of 20% (RR 0.80, 95% CI, 3-33, P = .02, I 2 = 68%). Conclusion Longer periods of smoking cessation decrease the incidence of postoperative complications.
AB - Objective We aimed to review randomized trials and observational evidence to establish the effect of preoperative smoking cessation on postoperative complications and to determine if there is an optimal cessation period before surgery. Methods We conducted a systematic review of all randomized trials evaluating the effect of smoking cessation on postoperative complications and all observational studies evaluating the risk of complications among past smokers compared with current smokers. We searched independently, in duplicate, 10 electronic databases and the bibliographies of relevant reviews. We conducted a meta-analysis of randomized trials using a random effects model and performed a meta-regression to examine the impact of time, in weeks, on the magnitude of effect. For observational studies, we pooled proportions of past smokers in comparison with current smokers. Results We included 6 randomized trials and 15 observational studies. We pooled the 6 randomized trials and demonstrated a relative risk reduction of 41% (95% confidence interval [CI], 15-59, P = .01) for prevention of postoperative complications. We found that each week of cessation increases the magnitude of effect by 19%. Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04). Observational studies demonstrated important effects of smoking cessation on decreasing total complications (relative risk [RR] 0.76, 95% CI, 0.69-0.84, P < .0001, I 2 = 15%). This also was observed for reduced wound healing complications (RR 0.73, 95% CI, 0.61-0.87, P = .0006, I 2 = 0%) and pulmonary complications (RR 0.81, 95% CI, 0.70-0.93, P = .003, I 2 = 7%). Observational studies examining duration of cessation demonstrated that longer periods of cessation, compared with shorter periods, had an average reduction in total complications of 20% (RR 0.80, 95% CI, 3-33, P = .02, I 2 = 68%). Conclusion Longer periods of smoking cessation decrease the incidence of postoperative complications.
KW - Meta-analysis
KW - Perioperative
KW - Smoking cessation
KW - Systematic review
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U2 - 10.1016/j.amjmed.2010.09.013
DO - 10.1016/j.amjmed.2010.09.013
M3 - Article
C2 - 21295194
AN - SCOPUS:79551672210
SN - 0002-9343
VL - 124
SP - 144
EP - 154
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 2
ER -