Identifying risk factors for surgical morbidity and mortality might improve the safety and efficacy of neurosurgical intervention. Cigarette smoking is a relatively common practice and is associated with several adverse health outcomes. The authors examined the relationship between smoking and intraoperative blood loss, postoperative outcomes, and survival following craniotomy for tumor resection.
A consecutive population of patients undergoing craniotomy for tumor resection between 2006 and 2009 was identified. Using multivariable models and Cox proportional hazard regression analysis, the authors assessed the relation between smoking and operative outcomes including blood loss, complication rates, hospital length of stay, 30-day mortality, and 1-year survival among patients who underwent craniotomy for tumor resection.
A total of 453 patients were included in this study: 237 patients never smoked, 54 quit smoking for at least 1 year, and 162 were current smokers. Current smoking status was an independent risk factor for higher intraoperative blood loss, complication risk, and lower 1-year survival following intervention relative to patients who never smoked. Patients who quit smoking had significantly higher mean blood loss, but did not carry a higher risk for other outcomes such as postoperative complications and 1-year mortality compared with patients who never smoked.
Current cigarette smoking is associated with poor surgical outcome and lower 1-year survival after undergoing craniotomy for tumor resection. However, quitting smoking and implementing strict smoking cessation programs may help mitigate these risks. Future research might investigate mechanisms underlying these associations.
Abbreviations used in this paper:BMI = body mass index; CAD = coronary artery disease; EBL = estimated blood loss; INR = international normalized ratio; LOS = length of stay; PTT = partial thromboplastin time.
The Centers for Disease Control and Prevention (CDC): Summary Health Statistics for U.S. Adults: National Health Interview Survey2008. http://www.cdc.gov/nchs/data/nhis/earlyrelease/200812_08.pdf [Accessed March 8 2012]
ChaichanaKLMcGirtMJFrazierJAttenelloFGuerrero-CazaresHQuinones-HinojosaA: Relationship of glioblastoma multiforme to the lateral ventricles predicts survival following tumor resection. J Neurooncol89:219–2242008
ChangSMParneyIFMcDermottMBarkerFGIISchmidtMHHuangW: Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg98:1175–11812003
HejblumGAtsouKDautzenbergBChouaidC: Cost-benefit analysis of a simulated institution-based preoperative smoking cessation intervention in patients undergoing total hip and knee arthroplasties in France. Chest135:477–4832009
KhannaAKXuJUberPABurkeAPBaquetCMehraMR: Tobacco smoke exposure in either the donor or recipient before transplantation accelerates cardiac allograft rejection, vascular inflammation, and graft loss. Circulation120:1814–18212009
Martínez-GarcíaEIrigoyenMGonzález-MorenoOCorralesLTeijeiraASalvoE: Repetitive nicotine exposure leads to a more malignant and metastasis-prone phenotype of SCLC: a molecular insight into the importance of quitting smoking during treatment. Toxicol Sci116:467–4762010
NassiriNClearyDRUeeckBA: Is cranial reconstruction with a hard-tissue replacement patient-matched implant as safe as previously reported? A 3-year experience and review of the literature. J Oral Maxillofac Surg67:323–3272009
SinghJAHoustonTKPonceBAMaddoxGBishopMJRichmanJ: Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res (Hoboken)63:1365–13742011
SørensenLTJørgensenT: Short-term pre-operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial. Colorectal Dis5:347–3522003
TønnesenHFaurschouPRalovHMølgaard-NielsenDThomasGBackerV: Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation. BMC Health Serv Res10:1212010
ZhangQTangXZhangZFVelikinaRShiSLeAD: Nicotine induces hypoxia-inducible factor-1alpha expression in human lung cancer cells via nicotinic acetylcholine receptor-mediated signaling pathways. Clin Cancer Res13:4686–46942007