Smoking Adversely Affects Urologic Surgery Outcomes

Current and former smokers are at higher risk of complications within 30 days after radical prostatectomy or cystectomy.
Current and former smokers are at higher risk of complications within 30 days after radical prostatectomy or cystectomy.

NEW ORLEANS—Current and former smokers may be at increased risk of adverse perioperative outcomes following radical prostatectomy and cystectomy compared with non-smokers, according to study data presented at the 2015 American Urological Association annual meeting.

The study, led by Akshay Sood, MD, of the Vattikuti Urology Institute, Henry Ford Hospital, Detroit, examined 30-day post-surgical morbidity and mortality in a cohort of 9,014 patients who underwent radical prostatectomy (RP), radical cystectomy, or nephrectomy. Of the 5,835 RP patients, 720 radical cystectomy patients, and 2,259 nephrectomy patients, 12.5%, 26.6%, and 21.1%, respectively, were active smokers at the time of surgery. The proportions of former smokers—those who had not smoked for at least a year before surgery—were 20.9%, 29.8%, and 18.8%, respectively.

For the 3 surgery groups combined, the overall complication and readmission rates differed significantly among the current, former, and non-smokers. The complication rates were 14.9%, 13.5%, and 11.1%, respectively, and the readmission rates were 10.9%, 8.7%, and 7.2%, respectively.

In the RP group, current smokers had a significant 4.5-fold increased odds for pulmonary complications and 3-fold increased odds of renal complications compared with non-smokers. Former smokers were not at increased odds for 30-day complications compared with non-smokers, and they had significantly decreased odds compared with current smokers.

In the radical cystectomy group, current smokers had a significant 2.5-fold increased odds of re-intervention and former smokers had a significant 2-fold increased odds of readmission compared with non-smokers. Smoking status was not associated with 30-day outcomes in the nephrectomy group.

Smoking status did not significantly affect perioperative mortality rates.

“These findings suggest that smoking not only predisposes to development of cancers, but also adversely affects the outcomes following definitive surgical treatment of these conditions,” Dr. Sood told Renal & Urology News. “Patients planning to undergo elective urological oncological procedures may be better counseled using the data from this study. Smoking cessation would not only improve patient outcomes but would also reduce the burden of healthcare expenditure associated with these adverse events.”

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