Robert Van Haren

M.D., M.S.P.H.

University of Cincinnati Medical Center

Associate Professor of Clinical Surgery

NLST (Learn more about this study)

NLST-1262

Jun 17, 2024

Analyzing the Utility of Smoking Cessation Requirements in the Morbidity and Mortality of Current and Former Smokers Undergoing Lung Resection

Lung cancer is responsible for nearly a quarter of all cancer-related deaths. These malignancies disproportionately impact underrepresented minority patients who have both a higher incidence of lung cancer and worse outcomes after diagnosis. These disparities are multi-factorial and prior research has identified a number of contributing factors including differences in socioeconomic status, patient preferences, stage at diagnosis, structural racism, and rates of surgical resection. Low rates of surgical resection are of particular concern given the clear role of surgical intervention in the treatment of lung malignancies. It is critical to identify and mitigate potential barriers for underrepresented minority patients with primary lung malignancies.

One such barrier is the role of required smoking cessation for current smokers prior to lung resection. A significant proportion (40%) of thoracic surgeons nationwide require smoking cessation prior to surgical resection for current smokers. This is done in an attempt to promote smoking cessation and improve postoperative outcomes such as pneumonia, respiratory failure, and death. There is significant disparity in the prevalence of active smoking between non-Hispanic White patients and minority patients; compared with 13.7% of the total US population, 19.1% of multiracial Americans, 22.6% of American Indians, and 14.6% of African Americans are current smokers. Although prior research suggests that post-resection outcomes are superior in never-smokers than patients with any history of smoking, there is no clear evidence suggesting that current smokers have worse outcomes than former smokers.

If outcomes are similar between current smokers and former smokers, then smoking cessation requirements at time of surgical resection may be an unnecessary barrier to surgical treatment that inordinately affects underrepresented minority populations. Our group previously conducted a single institution study using our institutional database comparing current smokers and former smokers who underwent surgical resection of a primary lung malignancy. The results demonstrated no difference in operative mortality, major morbidity, or a composite of morbidity and mortality, when controlling for preoperative pulmonary function status. By pooling the collective experiences of the institutions reporting to the NLST, the cohort of study patients would be provide a multi-institutional analysis of this research question. The proposed study seeks to evaluate the impact of smoking status (current smoker versus former smoker) on lung resection postoperative outcomes to determine the utility of smoking cessation requirements.

1. Identify potential barriers to surgery for underrepresented minority patients with primary lung malignancies

2. Evaluate the impact of smoking status (current smoker versus former smoker) on lung resection postoperative outcomes to determine the utility of smoking cessation requirements prior to lung resection

3. Use multivariable regression and/or propensity score matching to control for additional clinical variables to identify if smoking status itself was independently predictive of morbidity or mortality

4. Evaluate differences in demographics between current smokers and former smokers to better characterize these patient populations, particularly in terms of racial disparity