scholarly journals Smoking and Perioperative Outcomes

2011 ◽  
Vol 114 (4) ◽  
pp. 837-846 ◽  
Author(s):  
Alparslan Turan ◽  
Edward J. Mascha ◽  
Dmitry Roberman ◽  
Patricia L. Turner ◽  
Jing You ◽  
...  
Keyword(s):  
Perioperative Risk ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Inclusion Criteria ◽  
Improvement Program ◽  
Surgical Quality ◽  
Individual Outcomes ◽  
American College Of Surgeons ◽  
Never Smokers ◽  
Never Smoker

Background Patients are often concerned about the effects of smoking on perioperative risk. However, effective advice may be limited by the paucity of information about smoking and perioperative risk. Thus, our goal was to determine the effect of smoking on 30-day postoperative outcomes in noncardiac surgical patients. Methods We evaluated 635,265 patients from the American College of Surgeons National Surgical Quality Improvement Program database; 520,242 patients met our inclusion criteria. Of these patients, 103,795 were current smokers; 82,304 of the current smokers were propensity matched with 82,304 never-smoker controls. Matched current smokers and never-smokers were compared on major and minor composite morbidity outcomes and respective individual outcomes. Results Current smokers were 1.38 (95% CI, 1.11-1.72) times more likely to die than never smokers. Current smokers also had significantly greater odds of pneumonia (odds ratio [OR], 2.09; 95% CI, 1.80-2.43), unplanned intubation (OR, 1.87; 95% CI, 1.58-2.21), and mechanical ventilation (OR, 1.53; 95% CI, 1.31-1.79). Current smokers were significantly more likely to experience a cardiac arrest (OR, 1.57; 95% CI, 1.10-2.25), myocardial infarction (OR, 1.80; 95% CI, 1.11-2.92), and stroke (OR, 1.73; 95% CI, 1.18-2.53). Current smokers also had significantly higher odds of having superficial (OR, 1.30; 95% CI, 1.20-1.42) and deep (OR, 1.42; 95% CI, 1.21-1.68) incisional infections, sepsis (OR, 1.30; 95% CI, 1.15-1.46), organ space infections (OR, 1.38; 95% CI, 1.20-1.60), and septic shock (OR, 1.55; 95% CI, 1.29-1.87). Conclusion Our analysis indicates that smoking is associated with a higher likelihood of 30-day mortality and serious postoperative complications. Quantification of increased likelihood of 30-day mortality and a broad range of serious smoking-related complications may enhance the clinician's ability to motivate smoking cessation in surgical patients.

Optimal Timing of Palatoplasty in Infants With Comorbidities

2020 ◽  
pp. 105566562097624
Author(s):  
Christopher L. Kalmar ◽  
Vijay A. Patel ◽  
Zachary D. Zapatero ◽  
Mychajlo S. Kosyk ◽  
Jesse A. Taylor
Keyword(s):  
Adverse Events ◽  
Cleft Palate ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Optimal Timing ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: Ideal timing of palatoplasty continues to be debated given that early repair is thought to improve speech and hearing, whereas delayed repair is associated with less midface growth disruption. The purpose of this study is to elucidate optimal timing of palatoplasty in patients with comorbidities to mitigate perioperative complications. Design: Retrospective cohort study. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program Pediatric. Patients: Palatoplasty performed for children younger than the age of 2 years with comorbidities. Outcomes: Medical/surgical complications, reoperations, readmissions within 30 days postoperatively. Results: Patients with comorbidities having Veau I or II cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 125 days of age ( P < .001). Patients with comorbidities having Veau III cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 225 days of age ( P = .010). Patients with comorbidities having Veau IV cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 250 days of age ( P = .045). Conclusions: Infants with comorbidities having progressively increasing Veau classification demonstrate unique age-dependent perioperative thresholds, such that more extensive phenotypes are associated with better perioperative outcomes with older age at time of cleft palate repair.

scholarly journals The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database

2019 ◽  
Vol 14 (9) ◽  
Author(s):  
Matthew Lenardis ◽  
Benjamin Harper ◽  
Raj Satkunasivam ◽  
Zachary Klaassen ◽  
Christopher Wallis
Keyword(s):  
Body Mass Index ◽  
Bladder Cancer ◽  
Quality Improvement ◽  
Radical Cystectomy ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Major Complications ◽  
American College Of Surgeons ◽  
Perioperative Complication

Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients’ body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for nonmetastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m2, 18.5–25 kg/m2, 25–30 kg/m2, and >30 kg/m2. Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m2, 7.8% of patients with BMI 18.5–25 kg/m2, 7.9% of patients with BMI 25–30 kg/m2, and 10.8% of patient with BMI >30 kg/m2. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5–25 kg/m2, patients with BMI <18.5 kg/m2 (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07–4.78) and BMI >30 kg/m2 (OR 1.59; 95% CI 1.17–2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.

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