Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

BACKGROUND: Tobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence review on its impact on intraoperative and postoperative outcomes. OBJECTIVES: To undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intraoperative and postoperative harm. ELIGIBILITY CRITERIA PARTICIPANTS: Children aged 0–18 years undergoing anaesthetic or surgical procedures, any country, English language papers. EXPOSURE: ETS exposure assessed via questioning, observation or biological marker. OUTCOME MEASURES: Frequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes. RESULTS: 28 relevant studies were identified; 15 considered anaesthetic outcomes, 12 surgical outcomes, and 1 a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of perianaesthetic respiratory adverse events (Pooled risk ratio 2.52 CI 95% 1.68 to 3.77), and some evidence that ear and sinus surgery outcomes were poorer for children exposed to ETS. CONCLUSIONS: ETS exposure increases the risk of anaesthetic complications and some negative surgical outcomes in children, and this should be considered when planning surgery. Research is required to demonstrate whether changes in household smoking behaviour prior to surgery reduces risk of adverse outcomes, and to close the evidence gap around other outcomes such as wound healing and respiratory infections. TRIAL REGISTRATION NUMBER: Review registration number 42014014557.