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Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis
  1. Nicholas Gregory Ross Bayfield1,
  2. Adrian Pannekoek1,
  3. David Hao Tian2
  1. 1 Department of Clinical Services, Fiona Stanley Hospital, Perth, Australia
  2. 2 Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
  1. Correspondence to Dr Nicholas Gregory Ross Bayfield, Department of Clinical Services, Fiona Stanley Hospital, Murdoch WA 6150, Australia; Nicholas.Bayfield{at}


Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95%  CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95%  CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95%  CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

  • smoking
  • cardiac surgery
  • coronary artery bypass grafting
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  • Contributors NGRB and DHT contributed to the conception or design of the work. All authors contributed to the data collection, data analysis and interpretation, drafting the article, critical revision of the article and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Raw data used to perform statistical analysis will be available by directly contacting the corresponding author and requesting it. However, as this data is synthesised from a series of studies included in the meta-analysis, all of this data is already available online in the text of each respective article.

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