The association of vaping and electronic cigarette use with postoperative hypoxemia and respiratory complications: a retrospective cohort analysis
Abstract
Initially introduced as a safer alternative to smoking, electronic cigarettes (e-cigarettes) and vaping have since been associated with lung injury. Nevertheless, there is limited perioperative data on their potential contribution to the harmful effects of mechanical ventilation on the lungs. We hypothesized that, in adults undergoing noncardiothoracic surgeries, preoperative vaping/e-cigarette use is associated with hypoxemia during the first postoperative hour, and with an increased incidence of intraoperative and postoperative pulmonary complications. We conducted a retrospective cohort study in which we included patients reporting as vapers/e-cigarette users within one year before surgery as the exposure group, and nonvapers as the control group. The primary outcome was the time-weighted average (TWA) SpO 2 /F I O 2 ratio in the postanesthesia care unit during the first postoperative hour. The secondary outcome was a composite of intraoperative and postoperative pulmonary complications until discharge. We used entropy balancing to adjust for confounding, and fit weighted linear regression and logistic regression models to estimate treatment effects. A total of 110,940 patients met the inclusion criteria, and 1,941 of these were vapers/e-cigarette users. The average treatment effect on the treated for TWA SpO 2 /F I O 2 ratio ( N = 109,217) was estimated to be a mean difference of 4 (95% confidence interval [CI], 1 to 8; P = 0.007). This is equivalent to a 4% change in…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 110,940 participants or records.
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