Airway obstruction and perioperative complications in smokers undergoing abdominal surgery

Background: The goal of this study was to determine whether airway obstruct ion determined by preoperative spirometry predicts perioperative complicati ons in smokers undergoing abdominal surgery whose treatment is managed acco rding to current clinical practice. Methods: A pulmonary function database identified patients undergoing abdom inal surgery who met the following criteria for airway obstruction (n = 135 ): a forced expiratory volume less than 40% of predicted normal value, a fo rced expiratory volume:forced vital capacity ratio less than the lower limi t of predicted normal a smoking history of more than 20 pack-years, and an age older than 35 yr. A group of patients without airway obstruction (n = 1 35) was matched for gender, surgical site (upper vs. lon er abdominal), smo king history, and age. Medical records were reviewed by an abstractor to id entify perioperative complications that occurred within 30 days after surge ry. Results: The forced expiratory volume values were 0.9 +/- 0.21 (mean +/- SD ) and 2.9 +/- 0.6 1 in patients with and without airway obstruction, respec tively. When analyzed by conditional logistic regression using the 1:1 matc hed-pairs feature, including age, pack-year smoking history, site of incisi on, and current smoking status as covariates, in patients with airway obstr uction bronchospasm was more likely to develop (odds ratio, 6.9 [95% confid ence interval 1.2 to 38.4]) but the patients were not more likely to need p rolonged endotracheal intubation (odds ratio, 1.1 [95% confidence interval 0.4 to 3.2]). They mere also no more likely to need prolonged intensive car e admission or readmission. The frequency of other complications was less t han 5%. Conclusion: When other factors were considered, preoperative airway obstruc tion predicted the occurrence of bronchospasm, but not prolonged endotrache al intubation, in smokers undergoing abdominal surgery who are treated acco rding to current clinical practices.