Association Between Smoking and Post-Procedural Complications Following Nephrectomy in the U.S: A Non-Concurrent Cohort Study
Abstract
Introduction and Objective. Approximately ten million Americans undergoing surgical and non-surgical procedures annually are smokers with smoking history leading to increased postoperative complications. While evidence highlights these effects in nephrectomy due to malignancy, little research explores smoking’s impact for other reasons. This study examined the association between smoking history and frequency and type of postoperative complications following nephrectomy for non-malignant reasons. Methods. A non-concurrent cohort study, utilizing the 2014-2016 American College of Surgeons National Surgical Quality Improvement Program database, examined 22,996 patients aged eighteen years and older undergoing nephrectomy at U.S. hospitals, excluding those with malignancy. Exposure was smoking status at time of surgery. Primary outcome was postprocedural complications. Covariates included were BMI, age, race, gender, diabetes mellitus (DM), congestive heart failure (CHF), and steroid use. Unadjusted and adjusted logistic regression analyses determined the odds ratios (OR) with 95% confidence intervals (CI). Results. Among 4,519 current smokers who underwent nephrectomy, 16.09% experienced postsurgical complications compared to 16.17% of 18,477 non-smokers (p=0.898). The adjusted model found no associations between smoking and complications (OR 1.06; 95% CI: 0.96-1.18). Variables associated with increased post-operative complications included age of seventy years old or older, history of CHF, DM, ASA category of three or more, and radical and open nephrectomy. Conclusions-Implications. While our data revealed smoking status was not associated with an increased risk of post-surgical outcomes in patients undergoing nephrectomy, complications persist. It is important to consider recommendations controlling modifiable risk factors. Further research is needed for e-cigarettes, vapes, allograft survival, and recipient creatinine function.
Keywords
Nephrectomy, postoperative complications, mortality, smoking, nicotine dependence
Presentation Type
Oral Presentation
Association Between Smoking and Post-Procedural Complications Following Nephrectomy in the U.S: A Non-Concurrent Cohort Study
Introduction and Objective. Approximately ten million Americans undergoing surgical and non-surgical procedures annually are smokers with smoking history leading to increased postoperative complications. While evidence highlights these effects in nephrectomy due to malignancy, little research explores smoking’s impact for other reasons. This study examined the association between smoking history and frequency and type of postoperative complications following nephrectomy for non-malignant reasons. Methods. A non-concurrent cohort study, utilizing the 2014-2016 American College of Surgeons National Surgical Quality Improvement Program database, examined 22,996 patients aged eighteen years and older undergoing nephrectomy at U.S. hospitals, excluding those with malignancy. Exposure was smoking status at time of surgery. Primary outcome was postprocedural complications. Covariates included were BMI, age, race, gender, diabetes mellitus (DM), congestive heart failure (CHF), and steroid use. Unadjusted and adjusted logistic regression analyses determined the odds ratios (OR) with 95% confidence intervals (CI). Results. Among 4,519 current smokers who underwent nephrectomy, 16.09% experienced postsurgical complications compared to 16.17% of 18,477 non-smokers (p=0.898). The adjusted model found no associations between smoking and complications (OR 1.06; 95% CI: 0.96-1.18). Variables associated with increased post-operative complications included age of seventy years old or older, history of CHF, DM, ASA category of three or more, and radical and open nephrectomy. Conclusions-Implications. While our data revealed smoking status was not associated with an increased risk of post-surgical outcomes in patients undergoing nephrectomy, complications persist. It is important to consider recommendations controlling modifiable risk factors. Further research is needed for e-cigarettes, vapes, allograft survival, and recipient creatinine function.