Tobacco Use Linked to Postoperative Morbidity and Mortality Following Surgery for Kidney Cancer

TOBACCO CONSUMPTION is associated with significantly increased risk of minor and nonfatal major postoperative complications in patients undergoing nephrectomy for renal masses, regardless of surgical approach. This is according to the findings of a study presented at the 2021 annual meeting of the American Urological Association (AUA2021) by Kevin Melnick, MD, from the Division of Urology at Brigham & Women’s Hospital, Boston.

“Tobacco use has been shown to be an independent risk factor for postoperative morbidity following a variety of major surgeries,” Dr. Melnick said. “While tobacco use is both a risk factor for kidney cancer and associated with worse long-term survival, there are minimal data regarding its association with postoperative complications following nephrectomy.”

The retrospective cohort study carried out by Dr. Melnick and his colleagues made use of data from 108,430 patients undergoing nephrectomy for renal masses between 2003-2017 obtained from the Premier Hospital Database, a discharge dataset of about 20% of non-federal hospitalizations in the US. Almost 32% of these patients were identified as tobacco users who were more likely to be male and have higher rates of comorbidities. The researchers employed multivariable logistic regression analyses (MVA) to the correlation between tobacco use and the risk of 90-day postoperative complications, while adjusting for patient demographics and comorbidities, hospital characteristics, and disease status.

The results of MVA demonstrated that tobacco consumption was associated with a significantly increased risk of minor complications (Clavien 1-2; OR=1.17;95% CI 1.14–1.21, P<0.01) and nonfatal major complications (Clavien 3-4; OR=1.28; 95% CI 1.21–1.35, P<0.001). No differences were observed in 90-day postoperative mortality (OR=0.93; 95% CI, 0.79–1.11, P=0.407). Similar results were seen on all subgroup analyses by surgical approach (open radical, minimally invasive radical, open-partial, or minimally invasive nephrectomy). The group that underwent an open approach (radical and open partial nephrectomies) showed the largest differences (3-4%) in predictability of 90-day minor/major complications between smokers and non-smokers compared with the minimally invasive group, Dr. Melnick noted.

“Within complications by system, our analysis demonstrated significant differences between smokers and non-smokers in surgical, pulmonary, urologic, infectious, renal, gastrointestinal, cardiac, and neurologic outcomes, with the largest risk differences seen among surgical (2.8%), pulmonary (2.5%), and urologic (1.05%) complication rates,” Dr. Melnick revealed.

Given the findings of their study of the association of tobacco consumption with minor and nonfatal minor postoperative complications, it is, therefore, appropriate to encourage tobacco cessation among patients planning to undergo kidney surgery in an effort to optimize postoperative outcomes, Dr. Melnick urged.

References

  1. Melnick K, Yim K, Nayan M, et al. Impact of tobacco use on postoperative morbidity and mortality following surgery for renal masses. J Urol. 2021;26(3S, suppl):e1091. Abstract MP61-70. DOI: 10.1097/JU.0000000000002101.20