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12 November 2012

Smokers may fare worse after colorectal surgery

A new study finds that smokers face more complications and higher chances of death following major surgery for colorectal cancers and other diseases.

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Smoking has long been linked with slower recovery in general from injuries and surgeries, and now a new study finds that smokers face more complications and higher chances of death following major surgery for colorectal cancers and other diseases.

"We wanted to see if smoking has a specific effect on these patients... and really wanted to know if patients who stopped smoking had better results," said lead author Dr Abhiram Sharma, who was at the University of Rochester in New York during the study.

In September, a review of surgeries to repair knee ligaments found that smokers tended to have worse outcomes, including not being able to recover full knee function.

How the research was done

For the new report in the Annals of Surgery, Dr Sharma and colleagues used a nationally representative database of U.S. surgeries between 2005 and 2010.

Overall, the analysis included 47 574 patients who had undergone colorectal resection for cancer, diverticular disease or inflammatory bowel disease.

Roughly 60% of the patients had never smoked, 19% were former smokers and 20% were current smokers.

Never too late

During the first 30 days after surgery, current smokers had a 30% greater risk of having a major complication compared to patients who never smoked, and an 11% greater risk than ex-smokers.

Among 9 700 current smokers, for example, there were 1 497 major complications and 1 448 minor ones, whereas the 9 136 ex-smokers had 1 374 major and 1 386 minor complications. Never smokers, the largest group numbering 28 738, had 3 316 major complications and 3 462 minor ones.

Current smokers were also 1.5 times as likely to die within 30 days of surgery as never smokers.

In addition, the more "pack years" a person smoked, the stronger the odds of complications, the researchers note.

"We were not completely surprised (by the results). We know smoking is not good and there have been other studies that show smoking is a problem," Dr Sharma said.

There were, Dr Sharma's team acknowledges, some limitations in the study. For example, ex-smokers were defined as patients who had not smoked in at least one year. Therefore, some more recent ex-smokers may have been included with current smokers, leading the benefits of quitting to be underestimated.

Nonetheless, Dr Sharma said, the results show it's never too late to stop smoking.

"The sooner the better," he said.

(Reuters Health, November 2012)

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