INTRODUCTION: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. AIM: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). METHODS: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in-hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. RESULTS: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non-smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non-smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. CONCLUSION: The occurrence of PPCs in smokers is not different from non-smokers. FUNDING: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. REGISTRATION: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). PRIOR PRESENTATION: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.

Department of Anaesthesia Critical Care and Pain Medicine Massachusetts General Hospital Boston MA USA; Department of Anaesthesiology Columbia University NY USA

Department of Anaesthesiology Amsterdam University Medical Center Amsterdam the Netherlands; Department of Anaesthesiology Antoni van Leeuwenhoek Netherlands Cancer Institute Amsterdam the Netherlands

Department of Anaesthesiology Amsterdam University Medical Center Amsterdam the Netherlands; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology Amsterdam University Medical Center Amsterdam the Netherlands

Department of Anaesthesiology and Intensive Care Medicine Pulmonary Engineering Group Medical Faculty University Hospital Carl Gustav Carus Dresden Germany; Department of Intensive Care and Resuscitation Cleveland Clinic Cleveland OH USA; Department of Outcomes Research Cleveland Clinic Cleveland OH USA; Department of Cardiothoracic Anaesthesia Cleveland Clinic Cleveland OH USA

Department of Anaesthesiology and Intensive Care Medicine University Hospital Bonn Bonn Germany

Department of Anaesthesiology Intensive Care Medicine and Emergency Medicine Pain Therapy Bermannstrost Hospital Halle Halle Germany; Medical Faculty Martin Luther University of Halle Wittenberg Halle Germany

Department of Biotechnologies and Sciences of Life ASST Sette Laghi Anestesia Rianimazione Cardiologica University of Insubria Varese Italy

Department of Intensive Care Amsterdam University Medical Center Amsterdam the Netherlands; Department of Anaesthesiology Amsterdam University Medical Center Amsterdam the Netherlands

Department of Intensive Care Amsterdam University Medical Center Amsterdam the Netherlands; Department of Anaesthesiology Amsterdam University Medical Center Amsterdam the Netherlands; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology Amsterdam University Medical Center Amsterdam the Netherlands

Department of Intensive Care Amsterdam University Medical Center Amsterdam the Netherlands; Department of Critical Care Medicine Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Australia; Department of Intensive Care Austin Hospital Melbourne Australia; Department of Critical Care Melbourne Medical School Austin Hospita University of Melbourne Melbourne Australia; Department of Critical Care Hospital Israelita Albert Einstein São Paulo Brazil

Department of Intensive Care Amsterdam University Medical Center Amsterdam the Netherlands; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology Mahidol University Bangkok Thailand; Nuffield Department of Medicine University of Oxford Oxford UK

Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Department of Special Anaesthesia and Pain Therapy Medical University of Vienna Vienna Austria

Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Department of Special Anaesthesia and Pain Therapy Medical University of Vienna Vienna Austria; Department of Anaesthesiology and Intensive Care Medicine University Hospital Bonn Bonn Germany

Operating Services Critical Care and Anaesthesia Sheffield Teaching Hospitals University of Sheffield Sheffield UK

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ClinicalTrials.gov
NCT01601223