Role of Preoperative Cessation of Smoking and Other Factors in Postoperative Pulmonary Complications: A Blinded Prospective Study of Coronary Artery Bypass Patients
Section snippets
METHODS
From October 1986 to March 1987, 200 consecutive informed and consenting patients undergoing elective coronary artery bypass grafting were studied. Detailed cigarette smoking and cardiopulmonary histories were elicited, and bedside measurements of arterial blood gases, spirometry, and urinary cotinine were performed. Study patients were assessed immediately postoperatively, on postoperative days one and seven, and on the day of hospital dismissal for the development of postoperative respiratory
RESULTS
The characteristics of 192 study patients are shown in Table 1. Of the initial 200 patients, 7 patients were eliminated from the study because of onset of angina during bedside spirometry. Also excluded from analysis was one patient who died of massive hemorrhage intraoperatively.
Postoperative pulmonary complications occurred in 36 patients (18.7%) (Table 2), 14 of whom had multiple complications. Of these complications, 83% occurred within 48 hours postoperatively, and 95% occurred within 96
DISCUSSION
Preoperative cessation of smoking for less than 2 months in patients undergoing coronary artery bypass grafting does not seem to decrease postoperative respiratory morbidity below that found in current smokers. Supportive evidence has shown that improvement in ciliary15 and small airway function16, 17 and a decrease in production of sputum4 occur slowly for a period of weeks after cigarette smoking is stopped. Therefore, the risk of postoperative pulmonary complications remains high in patients
ACKNOWLEDGMENT
We thank Kris D. Hammel, R.R.T., R.P.F.T., and Peggy A. Hauswald, C.R.T.T., for help with data collection and performance of spirometry testing, Julie M. Vogen for assistance in preparing the manuscript, and Mary M. Ho for assistance with analysis of the data.
REFERENCES (29)
Tobacco smoking and pulmonary complications after operation
Lancet
(1944)- et al.
Risk factors for postoperative pneumonia
Am J Med
(1981) - et al.
Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis
Am J Surg
(1971) - et al.
Urinary cotinine as marker of breathing other people's tobacco smoke
Lancet
(1984) - et al.
Some studies of tracheobronchial clearance in man
Chest
(1973) - et al.
Reversibility of pulmonary function abnormalities in smokers
Am J Med
(1975) - et al.
Prediction of postoperative hypoxemia in smokers and non-smokers
Acta Anaesth Scand
(1979) - et al.
Postoperative respiratory morbidity: identification and risk factors
Aust N Z J Surg
(1982) A prospective study of the incidence of postoperative pulmonary complications
Br J Surg
(1968)- et al.
Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients
Anesthesiology
(1984)
Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels
Cotinine disposition and effects
Clin Pharmacol Ther
Smoking-induced changes in nicotine disposition: application of a new HPLC assay for nicotine and its metabolites
Clin Pharmacol Ther
Comparison of tests used to distinguish smokers from nonsmokers
Am J Public Health
Cited by (0)
- *
Current address: St. Francis Hospital and Medical Center, Topeka, Kansas.