Smoking and neurosurgical outcomes

June 18th, 2013 in Surgery /

The effects of long-term cigarette smoking on morbidity and mortality have long been known. In a more immediate sense, smoking in the days and weeks before surgery can lead to morbidity and complications for many surgical procedures. In this review, researchers from the University of California San Francisco and Yale University examined the surgical literature and, specifically, the neurosurgical literature to characterize the impact of active smoking on neurosurgical outcomes. They found strong evidence for the association between smoking and perioperative complications throughout the surgical literature. A small number of published reports specifically focus on neurosurgical procedures. On the basis of their findings—higher rates of intraoperative blood loss, greater need for intraoperative transfusions, higher rates of postoperative complications, and, in some patients with cranial cancer, shorter survival times—the researchers conclude that there are strong reasons for neurosurgeons to urge their patients to quit smoking prior to surgery and to encourage nationwide efforts to promote smoking cessation before surgical procedures.

Details on the researchers' findings are discussed in "The impact of smoking on neurosurgical outcomes. A review," by Darryl Lau, M.D., Mitchel S. Berger, M.D., Dhruv Khullar, B.A., and John Maa, M.D., published today online, ahead of published today online, ahead of print, in the Journal of Neurosurgery.

To obtain their data, the researchers performed a PubMed search for the terms "smoking and neurosurgery" or "tobacco and neurosurgery" for the time period 1950 through 2012. Additional sources of information were culled from reference lists of pertinent articles.

In their review, Lau and colleagues provide detailed descriptions of ways in which active smoking increases perioperative complications and cite numerous papers providing evidence of this. Specifically, the researchers cover the following topics:

In their examination of relationships between cigarette smoking and the risks of neurosurgery specifically, the researchers focus on three articles that demonstrate clear adverse effects of smoking on perioperative outcomes and supplement these data with additional information on later post-neurosurgery outcomes in smokers. The researchers organized the study findings according the three major types of neurosurgical procedures.

Cranial Surgery

Spine Surgery

Peripheral Nerve Surgery

In the Discussion section of this paper, the researchers describe evidence from clinical trials that show quitting smoking before surgery can lessen the risks of perioperative morbidity. Lau and colleagues review various ideas on how long before an operation that should take place and discuss how the topic of smoking cessation can provide a "teachable moment," in which the surgeon can use an upcoming neurosurgical procedure as a catalyst for a change in health behavior. The researchers strongly encourage neurosurgeons to counsel their patients on preoperative smoke cessation. On a public policy level, the researchers urge neurosurgeons "to take the lead in catalyzing constructive changes to minimize the impact of tobacco in the perioperative setting." The take-away message of the study according to lead author, Dr. John Maa, is "By utilizing the AAR (Ask, Advise, and Refer) strategy to counsel patients who smoke to stop preoperatively, can improve the quality of surgical outcomes and enhance patient safety. The potential impact on healthcare savings and lives saved could be enormous."

More information: Lau D, Berger MS, Khullar D, Maa J. The impact of smoking on neurosurgical outcomes. A review. Journal of Neurosurgery, published online, ahead of print, June 28, 2013; DOI: 10.3171/2013.5.JNS122287

Provided by Journal of Neurosurgery

"Smoking and neurosurgical outcomes." June 18th, 2013. http://medicalxpress.com/news/2013-06-neurosurgical-outcomes.html