ArticleJournal of artificial organs : the official journal of the Japanese Society for Artificial Organs2025
"Smoker's paradox" in in-hospital outcomes of left ventricular assist device implantation: a population-based analysis of National Inpatient Sample from 2015-2021.
Article in Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Left ventricular assist device (LVAD) implantation is a treatment option for advanced heart failure. The relationship between smoking and perioperative outcomes in LVAD implantation remains inconclusive, as evidence has been limited to single-center studies. This study aimed to examine the association between smoking and in-hospital outcomes of LVAD implantation in a large-scale population-based analysis. Patients who underwent LVAD implantation were selected from National Inpatient Sample from Q4 2015-2021. Multivariable logistic regression was used to compare in-hospital outcomes between smokers and non-smokers, where demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status were adjusted. There were 1346 (26.5%) smokers and 3737 (73.5%) non-smokers who underwent LVAD implantation. Smokers presented with a higher burden of comorbidities. After multivariable adjustment, smokers had lower in-hospital mortality (aOR 0.68, 95 CI 0.52-0.889, p < 0.01), MACE (aOR 0.74, 95 CI 0.554-0.987, p = 0.04), neurological complications (aOR 0.555, 95 CI 0.367-0.839, p = 0.01), stroke (aOR 0.508, 95 CI 0.311-0.832, p = 0.01), pericardial complications (aOR 0.705, 95 CI 0.545-0.913, p = 0.01), renal complications (aOR 0.691, 95 CI 0.595-0.801, p < 0.01), venous thromboembolism (aOR 0.523, 95 C = 0.295-0.929, p = 0.03), hemorrhage/hematoma (aOR 0.746, 95 CI 0.641-0.869, p < 0.01), and superficial wound complication (aOR 0.458, 95 CI 0.286-0.733, p < 0.01). Moreover, smokers had a shorter time from admission to operation (p = 0.02), shorter length of stay (p < 0.01), lower transfer out rate (p < 0.01), and lower hospital charge (p < 0.01). This study uncovered a "smoker's paradox" in LVAD implantation. These findings added to the long-standing observation of a "smoker's paradox" in cardiac surgery. However, the underlying reasons require further investigation.
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