Outcomes after Isolated CABG Surgery Related to Smoking Status

Background: Cigarette smoking has been implicated with adverse outcomes following coronary artery bypass grafting (CABG) surgery. To date, evidence linking smoking status on long-term mortality following CABG remains ambiguous. While advances in the practise of CABG now allow older patients with more comorbidities to undergo surgery, mortality following CABG continues to fall. There is therefore a need to re-evaluate the influence of preoperative smoking status on long-term mortality following CABG in the current era.Methods: ANZSCTS database was accessed to identify 21,486 patients undergoing CABG between 1 June 2001 and 31 December 2009 in this study. Preoperative characteristics, early outcomes and long-term survival of current smokers, previous smokers and non-smokers were compared using logistic regression, Kaplan–Meier survival curve and long-rank test methods.Results: Current smokers had a significantly higher length of ICU stay (p < 0.01) but their post-procedure length of hospital stay was lowest compared with non-smokers (p = 0.023). Logistic regression revealed smoking status was not an independent predictor for 30-day mortality. After adjusting for differences in patient variables, the incidence of late mortality was higher in both current smokers (OR, 1.41; p < 0.001) and previous smokers (OR, 1.73; p < 0.001) compared to non-smokers.Conclusion: This study presents a strong positive relationship between smoking status and long-term mortality following CABG. This study presents additional evidence to the debate on the consideration of smoking status in patient selection for CABG. It also lends weight to preventive efforts at all time points for health care professionals. Background: Cigarette smoking has been implicated with adverse outcomes following coronary artery bypass grafting (CABG) surgery. To date, evidence linking smoking status on long-term mortality following CABG remains ambiguous. While advances in the practise of CABG now allow older patients with more comorbidities to undergo surgery, mortality following CABG continues to fall. There is therefore a need to re-evaluate the influence of preoperative smoking status on long-term mortality following CABG in the current era. Methods: ANZSCTS database was accessed to identify 21,486 patients undergoing CABG between 1 June 2001 and 31 December 2009 in this study. Preoperative characteristics, early outcomes and long-term survival of current smokers, previous smokers and non-smokers were compared using logistic regression, Kaplan–Meier survival curve and long-rank test methods. Results: Current smokers had a significantly higher length of ICU stay (p < 0.01) but their post-procedure length of hospital stay was lowest compared with non-smokers (p = 0.023). Logistic regression revealed smoking status was not an independent predictor for 30-day mortality. After adjusting for differences in patient variables, the incidence of late mortality was higher in both current smokers (OR, 1.41; p < 0.001) and previous smokers (OR, 1.73; p < 0.001) compared to non-smokers. Conclusion: This study presents a strong positive relationship between smoking status and long-term mortality following CABG. This study presents additional evidence to the debate on the consideration of smoking status in patient selection for CABG. It also lends weight to preventive efforts at all time points for health care professionals.