T. Orouji Jokar1, P. Rhee1, A. Azim1, N. Kulvatunyou1, T. O’Keeffe1, A. Tang1, R. Latifi1, D. J. Green1, L. Gries1, R. S. Friese1, B. Joseph1 1The University Of Arizona,Trauma/Surgery/Medicine,Tucson, AZ, USA
Introduction: The role of chronic smoking has been well established with adverse outcomes in several surgical disciplines. However, its effect on outcomes after trauma operations has never been explored. The aim of this study was to assess the effect of active smoking on outcomes in patients who underwent surgery after trauma.
Methods: We did a two year (2011-2012) analysis of national trauma data bank. We included all critically injured (minimum AIS≥3, and required ICU admission during their stay) adult trauma patients who underwent surgical procedure on day 1. Patients, who died in ED, arrived with no vital signs, intoxicated, and fatally injured (AIS≥6) were excluded from the analysis. Our outcome measures were in-hospital complications, mortality, failure to rescue (FTR), hospital and ICU length of stay, and days on ventilator. Patients were divided into two groups based on their smoking status. Groups were matched using propensity score matching after adjusting for age, gender, race, injury severity, head AIS, admission vitals, and comorbidities.
Results: After propensity score matching 17,198 patients (Smokers: 8,599, Non-Smokers: 8,599) were included in the analysis. Mean age of the population was 46±18, 75% were male, median [IQR] ISS was 16 [10-25], median [IQR] AIS was 4[3-4], and overall mortality in our population was 8%. There was no difference in basic demographics of the groups. Overall rate of complications was significantly higher in smokers compared to non-smokers (52% vs 47%, p<0.001) and they were more likely to develop surgical site wound complications compared to non-smokers (4% vs 3%, p=0.02). Smokers had longer ICU length of stay (Median [IQR]: 3[2-7] vs. 3[2-6], p=0.04) and ventilator days (Median [IQR]: 0[0-3] vs. 0[0-2], p=0.02) compared to non-smokers. Overall mortality rate (6% vs 9%, p<0.001) and failure to rescue (4.6% vs 6%, p<0.001) were significantly lower in smokers compared to non-smokers.
Conclusion: Overall in-hospital and post-surgical complications were significantly higher in current smokers; however, it appears from our study that after controlling for comorbidities and other patient factors, active smokers have a survival advantage. Further investigation in elucidating the physiological and mechanistic basis of this association is required.