J. Sipko2, P. Deol2, T. Reljic2, F. Velez-Cubian2, C. Moodie1, J. Garrett1, J. Fontaine1,2, E. Toloza1,2 1Moffitt Cancer Center And Research Institute,Tampa, FL, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: Patients’ smoking history, including smoking status and length of smoking cessation prior to surgery, have been reported as risk factors for post-operative (post-op) atrial fibrillation (A-fib) after non-cardiac thoracic surgery. However, no research to date has determined if smoking history serves as a risk factor for A-fib following lobectomies performed via the minimally invasive robotic-assisted technique. The present study sought to determine the effect of patients’ smoking history and length of smoking cessation prior to surgery on the risk of developing A-fib following robotic-assisted video-thoracoscopic (RAVT) lobectomy to allow for more appropriate dispositioning of patients.
Methods: This study is a retrospective, cross-sectional, observational study, in which data was collected by chart review of 450 consecutive eligible patients who underwent RAVT lobectomy by a single surgeon between October 2010 and August 2017. The presence of new onset post-op A-fib was analyzed in patients who never smoked, currently smoke (including those who quit within two months prior to surgery), quit smoking between 2-12 months prior to surgery, and quit smoking >12 months in order to identify an optimal timeframe for smoking cessation. Odds ratios were calculated using logistic regression, with a 95% confidence interval.
Results: Our cohort consisted a median age of 68 yr (IQR 61-74), a median BMI of 27.35 kg/m2 (IQR 24-31), and a median BSA of 1.87 m2 (IQR 1.71-2.04), with only 9.75% of patients developing post-op A-fib. A univariate logistic regression yielded a statistically significant association between smoking status and post-op A-fib (P=.013), but this association was lost when adjusting for age, hypertension, and FEV-1. However, patients who quit smoking >12 months prior to surgery demonstrated increased odds of developing A-fib compared to those who never smoked, even while adjusting for age, hypertension, and FEV-1 (OR 4.74 (95%CI 1.05-21.35), P=0.04). Current smokers and patients who quit smoking 2-12 months prior to surgery also had increased odds of developing A-fib when compared to those who never smoked; however, these results were not statistically significant (OR 2.65 (95%CI 0.49-14.28), P=0.26) and (OR 3.90 (95%CI 0.59-26.64), P=0.17). Former smokers who quit >12 months also possessed more pre-operative comorbidities (median 3, mean 2.96, P=0.04) compared to current smokers (median 2, mean 2.44, P=0.04) and former smokers who quit between 2-12 months prior to surgery (median 2, mean 2.57, P=0.04).
Conclusions: Former smokers who quit greater than 12 months prior to surgery were associated with an increased risk of post-op A-fib compared to never smokers, current smokers, and smokers who quit between 2-12 months prior to RAVT lobectomy. This finding may be explained by former smokers who quit >12 months prior to surgery having a greater number of comorbidities compared to the other 3 groups.