Associations between smoking and postoperative complications following elective craniotomy

BACKGROUND: Evidence of postoperative complications associated with smoking has varied. We conducted this study to clarify the relationships between tobacco smoking and postoperative complications following craniotomy.METHODS: A retrospective cohort analysis identified 800 patients who underwent cranial surgery with general anesthesia at a medical center with 2700 beds in Seoul, Korea between January and December 2011.RESULTS: Prior smokers (34.8%) and current smokers (35.1%) were hospitalized for at least 11 days longer than never smokers (25.5%) (x2 = 6.74, P=0.036). There were no statistically significant differences in the incidence of postoperative complications among never smokers (5.2%), prior smokers (9.6%), and current smokers (9.6%). The incidences of postoperative complications among prior smokers (9.6%) and current smokers (9.6%) were similar. Comparisons between never smokers (25.5%) and current smokers (34.9%) showed smokers had longer hospital stays and a higher incidence of complications (χ2=6.74, P=0.012). The incidence of major complications (χ2=5.27, P=0.024) and overall complications (χ2=4.84, P=0.033) were also significantly higher among smokers than never smokers. The impact of smoking status on postoperative complications was not identified.CONCLUSIONS: We found significant associations between smoking status and postoperative complications. The incidence of major complications was twice as high among smokers as among never smokers. Therefore, it is recommended to continuously monitor current smokers to prevent postoperative complications after craniotomy.