Smoking Increases Risk for Complications after Colorectal Surgery

Summary and Comment |
October 31, 2013

Smoking Increases Risk for Complications after Colorectal Surgery

  1. Douglas K. Rex, MD

Clinicians should use this opportunity to encourage smoking cessation in patients who will likely need such surgery.

  1. Douglas K. Rex, MD

Previous studies have demonstrated an association between cigarette smoking and increased risk for infectious complications, anastomotic leaks, strictures, and overall complications after colorectal surgery. Now, using data from the American College of Surgeons National Surgical Quality Improvement Program (2005–2010) database, researchers examined whether cigarette smoking was associated with risk for morbidity or mortality 30 days after colorectal surgery for cancer (26,333 patients), diverticular disease (14,019) or inflammatory bowel disease (7222).

All patients were categorized as never-smokers, ex-smokers, or current smokers. Results were as follows:

In univariate analyses:

  • Current smokers had the highest rates of infectious complications, pneumonia, return to the operating room, and incisional infection.

  • Former smokers had the highest rates of ventilator dependency, cardiac complications, renal complications, and 30-day mortality.

In multivariate analyses:

  • Current smokers were at elevated risk for incisional infection, infectious complication, and major complication (adjusted odds ratio, 1.3 for each) and mortality (adjusted OR, 1.5) in the 30 days after surgery for either benign or malignant disease.

  • Results were similar in subanalyses of patients with Crohn disease and of patients without comorbidities.

  • A dose-dependent relationship was observed between amount of smoking and mortality: Patients in the highest use category (≥60 pack-years) had the highest mortality risk (adjusted OR, 1.85).


These findings might be used to encourage smoking discontinuation in patients in whom elective colorectal resections are anticipated (e.g., patients with chronic active inflammatory bowel disease who are not responding to medical therapy or patients with frequent attacks of diverticulitis). Unfortunately, whether discontinuation of smoking will reduce the risk for complications, and how long patients would need to stop for this to occur, remain unclear.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics


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