Annals of Surgical Oncology

, Volume 19, Issue 5, pp 1430–1438

Adverse Effects of Smoking on Postoperative Outcomes in Cancer Patients


    • Department of SurgeryUniversity of Colorado at Denver
  • Mary T. Hawn
    • The Center for Surgical, Medical Acute Care Research and Transitions (C-SMART)Birmingham Veterans Affairs Hospital
    • Section of Gastrointestinal Surgery, Department of SurgeryUniversity of Alabama at Birmingham
  • Elizabeth J. Campagna
    • The Center for Surgical, Medical Acute Care Research and Transitions (C-SMART)Birmingham Veterans Affairs Hospital
    • Colorado Health OutcomesUniversity of Colorado at Denver
  • William G. Henderson
    • Colorado Health OutcomesUniversity of Colorado at Denver
  • Jasvinder A. Singh
    • The Center for Surgical, Medical Acute Care Research and Transitions (C-SMART)Birmingham Veterans Affairs Hospital
    • Division of Rheumatology, Department of MedicineUniversity of Alabama at Birmingham
    • Department of Orthopedic SurgeryMayo Clinic School of Medicine
  • Thomas Houston
    • Center for Health Quality, Outcomes & Economic Research (CHQOER)Bedford VAMC
    • UMass Center for Clinical and Translational SciencesUniversity of Massachusetts Medical School
Healthcare Policy and Outcomes

DOI: 10.1245/s10434-011-2128-y

Cite this article as:
Gajdos, C., Hawn, M.T., Campagna, E.J. et al. Ann Surg Oncol (2012) 19: 1430. doi:10.1245/s10434-011-2128-y



The possible negative effects of smoking on postoperative outcomes have not been well studied in cancer patients.


We used the VA Surgical Quality Improvement Program (VASQIP) database for the years 2002–2008, which assesses preoperative risk factors and postoperative outcomes for patients undergoing major surgery within the VA healthcare system.


Compared with never smokers, prior smokers and current smokers with GI malignancies were significantly more likely to have surgical site infection (SSI) (odds ratio [OR], 1.25; 95% confidence interval [95% CI], 1.09–1.44) (OR, 1.20; 95% CI, 1.05–1.38), combined pulmonary complications (combined pulmonary outcome [CPO]: pneumonia, failure to wean from ventilator, reintubation) (OR, 1.60; 95% CI, 1.38–1.87) (OR, 1.96; 95% CI, 1.68–2.29), and return to the operating room (OR, 1.20; 95% CI, 1.03–1.39) (OR, 1.31; 95% CI, 1.13–1.53), respectively. Both prior and current smokers had a significantly higher mortality at 30 days (OR, 1.50; 95% CI, 1.19–1.89) (OR, 1.41; 95% CI, 1.08–1.82) and 1 year (OR, 1.22; 95% CI, 1.08–1.38) (OR, 1.62; 95% CI, 1.43–1.85). Thoracic surgery patients who were current smokers were more likely to develop CPO (OR, 1.62; 95% CI, 1.25–2.11) and mortality within 1 year (OR, 1.50; 95% CI, 1.17–1.92) compared with nonsmokers, but SSI rates were not affected by smoking status. Current smokers had a significant increase in postsurgical length of stay (overall 4.3% [P < .001], GI 4.7% [P = .003], thoracic 9.0% [P < .001]) compared with prior smokers.


Prior and current smoking status is a significant risk factor for major postoperative complications and mortality following GI cancer and thoracic operations in veterans. Smoking cessation should be encouraged prior to all major cancer surgery in the VA population to decrease postoperative complications and length of stay.

Supplementary material

10434_2011_2128_MOESM1_ESM.doc (126 kb)
Supplementary material 1 (DOC 126 kb)

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© Society of Surgical Oncology 2011