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Background <p>While converging evidence suggests that current smoking does not affect long-term survival after esophagectomy, the impact of current smoking on short-term outcomes remains inconclusive based on previous small-scale institutional studies. This study aimed to compare 30-day post-esophagectomy outcomes between current smokers and nonsmokers using a&#xa0;nationwide registry to offer a&#xa0;more comprehensive perspective.</p> Methods <p>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) esophagectomy-targeted database from 2016 to 2022 was used. Multivariable logistic regression was used to compare 30-day postoperative outcomes between current smokers and nonsmokers while adjusting for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and pathologic staging of the malignancy.</p> Results <p>There were 1808 (22.93%) and 6079 (77.07%) current smokers and current nonsmokers who underwent esophagectomy, respectively. Current smokers had higher risks of mortality (adjusted odds ratio, aOR = 1.671; <i>p</i> &lt; 0.01); pulmonary complications (aOR = 1.625; <i>p</i> &lt; 0.01) including pneumonia (aOR = 1.558; <i>p</i> &lt; 0.01), unplanned reintubation (aOR = 1.743; <i>p</i> &lt; 0.01), and prolonged mechanical ventilation (aOR = 1.773; <i>p</i> &lt; 0.01); renal complications (aOR = 1.51; <i>p</i> = 0.02) including acute renal failure (aOR = 1.64; <i>p</i> = 0.04); wound complications (aOR = 1.231; <i>p</i> &lt; 0.01); sepsis (aOR = 1.304; <i>p</i> &lt; 0.01); anastomotic leak (aOR = 1.264; <i>p</i> &lt; 0.01); and unplanned reoperation (aOR = 1.366, <i>p</i> &lt; 0.01) as well as a&#xa0;longer length of stay (<i>p</i> = 0.01).</p> Conclusion <p>Current smoking is an independent risk factor for postoperative mortality and complications after esophagectomy. Preoperative smoking cessation may have potential benefits in improving surgical outcomes.</p>

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Current smoking is an independent risk factor for 30-day mortality and morbidities after esophagectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2016 to 2022

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Renxi Li

摘要

Background

While converging evidence suggests that current smoking does not affect long-term survival after esophagectomy, the impact of current smoking on short-term outcomes remains inconclusive based on previous small-scale institutional studies. This study aimed to compare 30-day post-esophagectomy outcomes between current smokers and nonsmokers using a nationwide registry to offer a more comprehensive perspective.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) esophagectomy-targeted database from 2016 to 2022 was used. Multivariable logistic regression was used to compare 30-day postoperative outcomes between current smokers and nonsmokers while adjusting for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and pathologic staging of the malignancy.

Results

There were 1808 (22.93%) and 6079 (77.07%) current smokers and current nonsmokers who underwent esophagectomy, respectively. Current smokers had higher risks of mortality (adjusted odds ratio, aOR = 1.671; p < 0.01); pulmonary complications (aOR = 1.625; p < 0.01) including pneumonia (aOR = 1.558; p < 0.01), unplanned reintubation (aOR = 1.743; p < 0.01), and prolonged mechanical ventilation (aOR = 1.773; p < 0.01); renal complications (aOR = 1.51; p = 0.02) including acute renal failure (aOR = 1.64; p = 0.04); wound complications (aOR = 1.231; p < 0.01); sepsis (aOR = 1.304; p < 0.01); anastomotic leak (aOR = 1.264; p < 0.01); and unplanned reoperation (aOR = 1.366, p < 0.01) as well as a longer length of stay (p = 0.01).

Conclusion

Current smoking is an independent risk factor for postoperative mortality and complications after esophagectomy. Preoperative smoking cessation may have potential benefits in improving surgical outcomes.