SESSION TITLE: Tobacco Cessation and Prevention
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Analysis of duration of preoperative smoking cessation with 30-day outcome for thoracoscopic lobectomy performed for lung cancer.
METHODS: Our institutional STS General Thoracic Surgery Database was queried for outcomes of thoracoscopic (VATS) lobectomy patients. Smoking status was divided into 5 groups: never smokers, > 12 months, 1-12 months, 0.5-1 month preoperative cessation, and current smokers. Relationship with the patient-reported smoking status was analyzed using Kruskall-Wallis and Fischer’s exact test for continuous and categorical variables respectively. The odds ratios for different post-operative (postop) outcomes amongst the 5 groups were adjusted for age, COPD, neoadjuvant chemotherapy, FEV1, DLCO and intraoperative PRBC transfusion using a multivariate logistic regression model.
RESULTS: Of 706 lobectomy patients with complete data from Oct.2008 to July 2014, 685 (97 %) had VATS approach. 25 (3.6%) VATS patients had robot assistance. 10.1 % were never-smokers; 39.7%, 18.8% and 7.4% were ex-smokers of ≥ 12, 1-12 and 0.5-1 months respectively, while 23.9% were current smokers. The median pack-year history was 0, 40, 40, 40 and 45 for each group respectively .The current smokers and recent quitters (0.5-1 month group) had significantly lower age (median 62 years), higher incidence of COPD (49%) and along with 1-12 month group, lower pre-operative FEV1 (median- 73 and 75.5%) and DLCO (median 67and 72.5%); p< 0.001 for all. Compared to never-smokers, the recent quitters had significantly higher odds for postoperative pulmonary complications (OR= 2.9; p=0.02), in-hospital stay >3 days (OR= 3.7; p= 0.002), and post-op PRBC transfusion (OR= 6.3; p=0.05).
CONCLUSIONS: In a center performing mostly VATS lobectomy, a beneficial effect of preoperative smoking cessation on lobectomy was observed only after 30-days. Long cessation intervals reduce pulmonary complications and hospital stays significantly compared to continued smoking status.
CLINICAL IMPLICATIONS: For thoracoscopic lobectomy, brief smoking cessation (30 days or less) provides no immediate advantage and may actually increase complications. Proactive initiation of smoking cessation counselling at first patient contact is essential. Delay of surgery until 30 days after smoking cessation should be considered.
DISCLOSURE: The following authors have nothing to disclose: Athar Battoo, Todd Demmy, Kristopher Attwood, Mark Hennon, Chukwumere Nwogu, Anthony Picone, Elisabeth Dexter
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