Impact of smoking status and chronic obstructive pulmonary disease on pulmonary complications post lung cancer surgery
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2022-03-01
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PLoS ONE
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PUBLIC LIBRARY SCIENCE
Melbourne Authors
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Medicine (Austin & Northern Health)
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Journal Article
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Jeganathan, V., Knight, S., Bricknell, M., Ridgers, A., Wong, R., Brazzale, D. J., Ruehland, W. R., Rahman, M. A., Leong, T. L. & McDonald, C. F. (2022). Impact of smoking status and chronic obstructive pulmonary disease on pulmonary complications post lung cancer surgery. Plos One, 17 (3 March), https://doi.org/10.1371/journal.pone.0266052.
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Abstract
INTRODUCTION: Smoking and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of post-operative pulmonary complications (PPCs) following lung cancer resection. It remains unclear whether smoking cessation reduces this risk. METHODS: Retrospective review of a large, prospectively collected database of over 1000 consecutive resections for lung cancer in a quaternary lung cancer centre over a 23-year period. RESULTS: One thousand and thirteen patients underwent curative-intent lobectomy or pneumonectomy between 1995 and 2018. Three hundred and sixty-two patients (36%) were ex-smokers, 314 (31%) were current smokers and 111 (11%) were never smokers. A pre-operative diagnosis of COPD was present in 57% of current smokers, 57% of ex-smokers and 20% of never smokers. Just over 25% of patients experienced a PPC. PPCs were more frequent in current smokers compared to never smokers (27% vs 17%, p = 0.036), however, no difference was seen between current and ex-smokers (p = 0.412) or between never and ex-smokers (p = 0.113). Those with a diagnosis of COPD, independent of smoking status, had a higher frequency of both PPCs (65% vs 35%, p<0.01) and overall complications (60% vs 40%, p<0.01) as well as a longer length of hospital stay (10 vs 9 days, p<0.01). CONCLUSION: Smoking and COPD are both associated with a higher rate of PPCs post lung cancer resection. COPD, independent of smoking status, is also associated with an increased overall post-operative complication rate and length of hospital stay. An emphasis on COPD treatment optimisation, rather than smoking cessation in isolation, may help improve post-operative outcomes.