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A Prospective Study of Tobacco Smoking as a Predictor of Complications in General Surgery

  • Miguel Delgado-Rodríguez (a1) (a2), Marcelino Medina-Cuadros (a2), Gabriel Martínez-Gallego (a2), Antonio Gómez-Ortega (a2), Marcial Mariscal-Ortiz (a1), Silvia Palma-Pérez (a1) and María Sillero-Arenas (a3)...

To analyze whether tobacco smoking is related to nosocomial infection, admission to the intensive care unit, in-hospital death, and length of stay.


A prospective cohort study.


The Service of General Surgery of a tertiary-care hospital.


A consecutive series of patients admitted for more than 1 day (N = 2,989).


Sixty-two (2.1%) patients died and 503 (16.8%) acquired a nosocomial infection, of which 378 (12.6%) were surgical site and 44 (1.5%) were lower respiratory tract. Smoking (mainly past smoking) was associated with a worse health status (eg, longer preoperative stay and higher American Society of Anesthesiologists score). A long history of smoking (≥ 51 pack-years) increased post-operative admission to the intensive care unit (adjusted odds ratio [OR] = 2.86; 95% confidence interval [CI95], 1.21 to 6.77) and in-hospital mortality (adjusted OR = 2.56; CI95, 1.10 to 5.97). There was no relationship between current smoking and surgical-site infection (adjusted OR = 0.99; CI95, 0.72 to 1.35), whereas a relationship was observed between past smoking and surgical-site infection (adjusted OR = 1.46; CI95, 1.02 to 2.09). Current smoking and, to a lesser degree, past smoking augmented the risk of lower respiratory tract infection (adjusted OR = 3.21; CI95, 1.21 to 8.51). Smokers did not undergo additional surgical procedures more frequently during hospitalization. In the multivariate analysis, length of stay was similar for smokers and nonsmokers.


Smoking increases in-hospital mortality, admission to the intensive care unit, and lower respiratory tract infection, but not surgical-site infection. Deleterious effects of smoking are also observed in past smokers and they cannot be counteracted by hospital cessation programs.

Corresponding author
Division of Preventive Medicine and Public Health, University of Jaén, Building B-3, 23071 Jaén, Spain
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Infection Control & Hospital Epidemiology
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