Impact of Smoking on Perioperative Outcomes Following Cardiac Surgery (23 NACSA 02)

The Data will be used for the purpose of the following study: The Impact of Smoking on Perioperative Outcomes following Cardiac Surgery

Smoking has been demonstrated to increase the risks of complications after surgery, such as impaired wound healing, heart and breathing problems, requiring admission to intensive care or returning to theatre. However, there is little evidence available currently on the current rates of smoking in patients undergoing cardiac surgery and the risk of post-operative complications among different groups of patients depending on: the type of operation they receive, the reason they present to hospital, as well as geographical and socio-economic differences. This is particularly important as patients undergoing cardiac surgery are often frail with numerous medical problems.

The purpose of this study is to use the National Institute for Cardiovascular Outcomes Research (NICOR) data to provide up-to-date evidence on the prevalence of smoking in patients undergoing elective cardiac surgery, to compare the rates of post-operative complications between smokers, ex-smokers, and non-smokers, and to investigate any differences in the risk of complications based on type of operation, geographical region, and socioeconomic status. Identifying patients who are most likely to have complications secondary to smoking will help us to design a bespoke smoking-cessation intervention focused on these groups in the future, and to identify areas of greatest research need to improve outcomes.

The primary outcome will be in-hospital mortality compared between smokers and non-smokers.

The secondary outcomes will include:

• Prevalence of current smoking, previous smoking, and non-smokers

• Length of hospital stay

• Return to theatre

• Admission to ITU

• Post-operative complications

The following NHS England Data is accessed:

• NICOR Adult Cardiac Surgery (NACSA)

The data will be minimised as follows:

Inclusion:

• Adults aged >18 years

• Any elective cardiac surgical procedure recorded by NICOR between

• Documented smoking status

• Date of procedure from 01/01/2012 to 31/12/2022

Exclusion:

• Age below 18

• Non-surgical procedure

• Emergency admissions

• Unknown or no documented smoking status

The lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;

The lawful basis for processing special category data under the UK GDPR is:

Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

This project was reviewed and supported by the NICOR Research Access Committee (RAC) on 31/07/2023.

The National Institute for Cardiovascular Outcomes Research (NICOR) database will be interrogated retrospectively for patients undergoing cardiac surgery in the UK over approximately a 10-year period. We are requesting data for 2012/13 to 2021/22 inclusive. The inclusion criteria will be adults over 18 years, undergoing NICOR-recorded cardiac procedures. Only elective cases will be included. Those without a recorded smoking status will be excluded.

The data will be presented in aggregated form. No individual record will be identifiable in the report. Appropriate summary statistics will be chosen, dependent on the nature of the data and its distribution. We plan to perform regression analysis to investigate the effect of smoking on outcomes; as well as the prevalence of smoking with geographical variations and different procedures. Results will be adjusted using known risk models where possible, such as EuroSCORE II. Rates will be presented with 95% confidence intervals.

Not stated in the register.

Smoking-related diseases and complications cost the NHS £2 billion per year and are the leading cause of health inequalities in England, accounting for over half the difference in the risk of premature death between socioeconomic groups. The need to address tobacco-smoking and develop targeted strategies to under-served groups has been identified by the NICE guidance. It is therefore imperative to identify high-risk patients who will benefit most from smoking-cessation interventions and further research.

This study will provide a contemporary update on the prevalence of smoking amongst patients undergoing cardiac surgery in the UK, and generate evidence on the impact of smoking on perioperative outcomes amongst different subgroups of patients, thus identifying any variations and inequalities across the type of operations performed, geographical area, and socioeconomic status. The results will inform the development of a bespoke smoking-cessation intervention and service design for cardiac surgery; and may be further extrapolated to other speciality areas.

Not stated in the register.