Impact of Smoking on Trauma Patients

Background
The harmful effects of smoking have been well documented in the medical literature for decades. To further the support of smoking cessation, we investigate the effect of smoking on a less studied population, the trauma patient.

Methods
All trauma patients admitted to the surgical ICU at the LAC+USC medical center between January 2007 and December 2011 were included. Patients were stratified into 2 groups - current smokers and non-smokers. Demographics, admission vitals, comorbidities, operative interventions, injury severity indices and APACHE II scores were documented. Univariate and multivariate modeling was performed. Outcomes studied were mortality, duration of mechanical ventilation and length of hospitalization.

Results
A total of 1754 patients were available for analysis, 118 (6.7%) patients were current smokers. The mean age was 41.4±20.4, 81.0% male and 73.5% suffered blunt trauma. Smokers had a higher incidence of congestive heart failure (4.2% vs. 0.9%, p=0.007) and alcoholism (20.3% vs. 5.9%, p<0.001) but had a significantly lower APACHE II score. After multivariate regression analysis, there was no significant mortality difference. Patients who smoked spent more days mechanically ventilated (Beta Coefficient: 4.96 [1.37, 8.55, p=0.007]).

Conclusion
Smoking is associated with worse outcome in the critically ill trauma patient. On average, smokers spent 5 days longer requiring mechanical ventilation than nonsmokers.