Original articleGeneral thoracicImpact of Smoking Cessation Before Resection of Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Study
Section snippets
Data Source
The STS established the ongoing prospective General Thoracic Surgery Database on January 1, 1999. Data are submitted voluntarily for quality monitoring by multiple hospitals, group practices, and surgeons throughout the United States, which for this study included 79 centers. Each center or surgeon completes a standardized form that is keyed into certified software and harvested annually for submission to the Duke Clinical Research Institute, which is charged with maintaining and analyzing
Hospital Mortality
Although overall hospital mortality was low at 1.4% (109 of 7990), it was 1.5% among current or past smokers (105 of 6965) compared with 0.3% among patients who had never smoked (4 of 1025, Table 2). Mortality was lower among patients with longer intervals of smoking cessation before resection (Table 3,Fig 2); however, no sharp transition to low risk was identified. Cause of death was not available in the STS database.
Pulmonary Complications
Major pulmonary complications were infrequent (5.7% of patients; 456 of
Comment
Most patients undergoing pulmonary resection for bronchogenic carcinoma have some smoking history, and many are active smokers [3]; however, the optimal timing of smoking cessation before pulmonary resection remains uncertain. In delaying the operation, thoracic surgeons must balance the risk of local tumor growth (tumor doubling) [7], risk of metastasis, and patient anxiety [8] against the benefit of reduced operative risk [9]. This clinical dilemma arises frequently: Almost 30% of patients in
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