Impact of Environmental Tobacco Smoke (ETS) exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

Christopher Chiswell, Yasmin Akram

Research output: Contribution to journalArticlepeer-review

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Tobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure in children causes a number of known harms, but there is no established evidence review on its impact on intra- and post-operative outcomes.
To undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intra-operative and post-operative harm.
Eligibility Criteria
Participants: Children aged 0-18 years undergoing anaesthetic or surgical procedures, any country, English language papers
Exposure: Environmental tobacco smoke 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
Twenty eight relevant studies were identified; fifteen considered anaesthetic outcomes, twelve surgical outcomes, and one a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of peri-anaesthetic 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 environmental tobacco smoke.
Environmental tobacco smoke 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.
S/R Registration Number
PROSPERO ID 42014014557
Original languageEnglish
JournalArchives of Disease in Childhood
Early online date14 Jul 2016
Publication statusE-pub ahead of print - 14 Jul 2016


  • Anaesthetics
  • Paediatric Surgery
  • Public Health
  • Tobacco Smoke
  • Passive smoking


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