Influence of Active Cigarette Smoking on Postoperative Outcomes after Elective General Surgery: A Prospective Cohort Study
DOI:
https://doi.org/10.37762/jgmds.13-4.997Keywords:
Smoking, Tobacco Use, Elective Surgery, Postoperative Complications, Surgical-Site Infection, Pulmonary Complications, Hospital Stay, Smoking CessationAbstract
OBJECTIVES
This study aimed to assess the association between active cigarette smoking and postoperative morbidity and hospital stay among adults undergoing elective non-cardiac general surgery at a tertiary-care hospital in Pakistan.
METHODOLOGY
This prospective observational cohort study enrolled 280 adults aged 18–60 years undergoing elective general surgical procedures at Services Institute of Medical Sciences/Services Hospital, Lahore, from November 2024 to December 2025. Participants comprised 180 active smokers and 100 non-active smokers. Smoking exposure was quantified in pack-years. Patients received standard perioperative care and were followed through 30 days after discharge. Outcomes included pulmonary complications, surgical-site or wound-related complications, postoperative fever, cardiovascular events, and total hospital stay. Associations were assessed using chi-square testing, logistic regression for overall complications, and independent-samples testing for length of stay.
RESULTS
Overall postoperative complications occurred in 67/180 smokers (37.2%) and 13/100 non-smokers (13.0%), corresponding to an odds ratio of 3.96 (95% CI 2.0–7.7; p<0.001). Pulmonary complications were the most frequently reported adverse event among smokers. Among smokers with more than 11 pack-years, 55/121 (45.5%) developed at least one complication. Mean total hospital stay was 14.90 days in smokers and 7.58 days in non-smokers (reported p<0.001).
CONCLUSION
Active smoking was associated with substantially greater postoperative morbidity and longer hospitalisation after elective general surgery. Routine preoperative tobacco assessment, pack-year documentation, and structured cessation support should be incorporated into elective surgical pathways.
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