Smoking status and perioperative adverse events in patients undergoing cranial tumor surgery

  • Luis Padevit
  • Johannes Sarnthein
  • Martin Nikolaus Stienen
  • Niklaus Krayenbühl
  • Oliver Bozinov
  • Luca Regli
  • Marian Christoph NeidertEmail author
Clinical Study



Smoking is agreed to be a major health risk factor, but it is debated whether it has an influence on perioperative adverse events (AEs) in elective cranial tumor surgery.


We analyzed the 2013–2016 data from our prospective institutional patient registry. Consecutive patients undergoing elective microsurgical tumor surgery of a glioma or a meningioma were included. Patients were categorized as active smokers, former smokers, and non-smokers. AE were graded by the therapy-oriented Clavien–Dindo scale. Possible predictors of postoperative AE were identified with the help of a binomial logistic regression model.


We identified 798 patients, out of which 480 were non-smokers, 193 active smokers, and 125 former smokers. The rate of AEs for active smokers (30%, 95% CI [23–37%]) was indistinguishable from the AE rate of non-smokers (32%, 95% CI [28–37%]). No difference between smoking status was found looking at all AE individually, the odds ratio of suffering from local AE and systemic AE respectively were the same between all smoking groups. The modified Rankin scale at hospital admission was a strong and significant predictor of postoperative AE (P = 0.013).


Active smoking was not associated with an increased risk for postoperative AE, neither looking at the total number of AE nor looking at individual AE. Smoking status should therefore not be a major factor in preoperative decision making. Although not based on data of this study, doctors should always encourage patients to stop smoking due to its well-known detrimental health effect.


Adverse events AE Smoking Brain tumor Glioma Meningioma 



Adverse event


Clavien–Dindo grading system


Modified Rankin scale


Karnofsky performance scale


Length of stay




Odds ratio



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital ZurichZurichSwitzerland

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