• Alparslan Turan, Onur Koyuncu, Cameron Egan, Jing You, Kurt Ruetzler, Daniel I Sessler, and Jacek B Cywinski.
• From the Department of Outcomes Research (AT, OK, CE, KR, JBC, DIS), Departments of Quantitative Health Sciences and Outcomes Research (JY) and Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (KR, JBC).
• Eur J Anaesthesiol. 2018 Apr 1; 35 (4): 256-265.

BackgroundPreoperative smoking cessation is commonly advised in an effort to improve postoperative outcomes. However, it remains unclear for how long smoking cessation is necessary, and even whether a brief preoperative period of abstinence is helpful and well tolerated.ObjectiveWe evaluated associations between various periods of preoperative smoking cessation and major morbidity and death.DesignRetrospective cohort analysis.SettingAdults who had noncardiac surgery at the Cleveland Clinic Main Campus between May 2007 and December 2013.PatientsA total of 37 511 patients whose smoking history was identified from a preoperative Health Quest questionnaire. Of these patients, 26 269 (70%) were former smokers and 11 242 (30%) were current smokers. Of the current smokers, 9482 (84%) were propensity matched with 9482 former smokers (36%). We excluded patients with American Society of Anesthesiologists' physical status exceeding four, patients who did not have general anaesthesia, and patients with missing outcomes and/or covariables. When multiple procedures were performed within the study period, only the first operation for each patient was included in the analysis.Main Outcome MeasuresThe relationship between smoking cessation and in-hospital morbidity/mortality.ResultsThe incidence of the primary composite of in-hospital morbidity/mortality was 6.9% (656/9482) for all former smokers; the incidence was 7.8% (152/1951) for patients who stopped smoking less than 1 year before surgery, 6.3% (118/1977) for 1 to 5 years, 7.2% (115/1596) for 5 to 10 years and 6.9% (271/3457) for more than 10 years.ConclusionSmoking cessation was associated with reduced in-hospital morbidity and mortality which was independent of cessation interval.

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