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Effects of Smoking Status and Tobacco Load on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy
Collin Chase1, Diep Nguyen1, Ajay Varadhan1, Jessica Cobb1, Sarah Cool1, Gregory Fishberger1, Maykel Dolorit1, Emily Weeden1, Harrison Strang1, Rahul Mhaskar1, Joseph R. Garrett2, Carla C. Moodie2, Jacques P. Fontaine2, Jenna Tew2, Jobelle J.A.R Baldonado2, Eric Toloza3.
1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3University of South Florida Health Morsani College of Medicine; Moffitt Cancer Center, Tampa, FL, USA.

OBJECTIVE: Smoking status and pack-year tobacco history were investigated to determine effects on perioperative outcomes after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
METHODS: We retrospectively analyzed 709 consecutive patients who underwent RAVTS pulmonary lobectomy by one surgeon over 10.8 years. Patients were analyzed based on pack-year history and smoking status as Never, Former (quit >3 months before surgery), Recent (quit >2 weeks but <3 months before surgery), and Current. Variables were compared using Chi-Square (X2), Fisherís Exact test, Studentís t-test, and Kruskal-Wallis test, with significance at p≤0.05.
RESULTS: There were 132 Never Smokers, 396 Former Smokers, 68 Recent Smokers, and 113 Current Smokers. There were no significant differences in intraoperative complication rates, conversion-to-thoracotomy rates, hospital length of stay (LOS), or in-hospital mortality based on pack-year history. Pack-year history did not influence postoperative complications, except for postoperative mucous plug formation (OR=1.013, 95%CI=1.004-1.022, p=0.0044) and postoperative respiratory failure (OR=1.013, 95%CI=1.002-1.025, p=0.0244), which had increased risk relative to tobacco load. Smoking status had no influence on conversion-to-thoracotomy rates, hospital LOS, in-hospital mortality, or intraoperative and postoperative complication rates, except for estimated blood loss, which had an increased risk among Current, Recent, and Former Smokers compared to Never Smokers (p=0.0115), and postoperative respiratory failure, which had an increased risk among Current Smokers (p=0.0162).
CONCLUSIONS: Increased tobacco load may lead to increased postoperative pulmonary complications after RAVT pulmonary lobectomy, and patients should be encouraged to quit smoking prior to surgery. However, RAVT pulmonary lobectomy is feasible and safe even in current and recent smokers.


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