Prevalence of Smoking and Impact on Outcomes after Elective Cardiac Surgery in the United Kingdom

Objectives To evaluate the prevalence of smoking in the UK elective cardiac surgery population and its impact on postoperative outcomes. Design A retrospective observational cohort study. Setting Multicenter study using UK registry data from adults undergoing cardiac surgery. Participants People who underwent elective coronary artery bypass grafting, valve surgery, or surgery to the thoracic aorta between 2012 and 2022. Interventions Documented smoking status at the time of surgery. Measurements and main results Of 170,532 included patients, 7.7% were current smokers, 48.4% former smokers and 43.9% non-smokers. The prevalence of smoking did not change between 2012 and 2022. Current smokers present for surgery at a younger age. Despite a higher burden of comorbidities, smokers were not at increased risk of in-hospital mortality compared to former smokers or non-smokers. However, compared with non-smoking, smoking was associated with a higher risk of deep sternal wound infection (odds ratio [OR] 1.53; p < 0.01) and need for surgical debridement (OR 1.89; p < 0.01). Smokers were also more likely than non-smokers to require renal replacement therapy after aortic arch surgery (OR 1.37; p=0.049). There was no difference in the incidence of other complications between smokers and non-smokers. The mean length of hospital stay was shorter in smokers than non-smokers (9.1 v 9.2 days; hazard ratio 0.97; p < 0.01). Conclusions Smoking was less common in the UK elective cardiac surgery population than in other surgical cohorts within the study period. Smokers presented for surgery at a younger age, were more comorbid and had a higher risk of serious wound infections.