WASHINGTON — Tobacco use can have a detrimental effect on postoperative outcomes, which is why patients are urged to quit smoking as long as possible before surgery.

A new study in Seminars in Thoracic and Cardiovascular Surgery points out that, in lung cancer patients, longer term smoking cessation is associated with overall improvement in survival for lung cancer patients, but the effects of cessation shortly before lung surgery have been unclear. 1

In response, researchers from the DCVAMC and George Washington University, both in Washington sought to compare 30-day outcomes after lobectomy between active smokers, recent quitters and nonsmokers.

To do that, they retrospectively identified patients who underwent lobectomy for cancer at national VAMCs from 2012-2018 in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. The sample was stratified into three groups:

  • Smokers within two weeks of surgery (active smokers),
  • Those who quit between two weeks and three months prior to surgery (recent quitters) and
  • Nonsmokers.

Of 5,715 patients who met inclusion criteria, 2,696 were nonsmokers, 774 were recent quitters, and 2,245 were active smokers. After propensity matching, each group included 572 patients.

Results indicated that, compared with recent quitters, active smokers had 48% higher odds of suffering a pulmonary complication (95% confidence interval (CI): 1.03-2.14; p=0.035) and 72% higher odds of suffering multiple complications (CI: 1.07-2.76; p=0.026).

In addition, the study authors advised, compared with nonsmokers, active smokers had 81% higher odds of pulmonary complications (CI: 1.34-2.65; p=0.003).

No differences were detected, however, in outcomes comparing recent quitters to nonsmokers.

“Veterans undergoing lobectomy for cancer who quit 2 weeks before surgery had less pulmonary complications than active smokers,” the researchers concluded. “Recent quitters have similar outcomes to non-smokers. Surgeons should therefore encourage patients to quit smoking, including just prior to lung surgery.”


  1. Napolitano MA, Rosenfeld ES, Chen SW, Sparks AD, Antevil JL, Trachiotis GD. Impact of Timing of Smoking Cessation on 30-day Outcomes in Veterans Undergoing Lobectomy for Cancer. Semin Thorac Cardiovasc Surg. 2020 Nov 15:S1043-0679(20)30411-1. doi: 10.1053/j.semtcvs.2020.11.018. Epub ahead of print. PMID: 33207278.