Substance Use Among Iranian Cardiac Surgery Patients and Its Effects on Short-Term Outcome

BACKGROUND: We assessed the prevalence of substance use among patients undergoing coronary artery bypass graft and valve surgery in northwest Iran. We evaluated the postoperative complications and in-hospital mortality of patients with substance dependence and abuse. METHODS: In this prospective, observational study, we interviewed 600 patients during the preoperative visit in a tertiary referral educational hospital in northwest Iran. The definition of substance abuse and dependence was according to DSM-IV criteria. Postoperative complications and in-hospital mortality of patients with substance (cigarette, opium, and alcohol) dependence and abuse were compared with those in control patients who did not use these substances. RESULTS: In 600 studied patients, the prevalence of cigarette smoking was 42.1% (ex-smokers 26.0% and current smokers 16.1%,), prevalence of opium use was 12.0% (opium abuse 7.0% and opium dependence 5.0%), and alcohol consumption was 8.1% (alcohol abuse 7.4% and alcohol dependence 0.7%). The prevalence of cigarette smoking was 58.9% in men and 7.6% in women (P = 0.001). Postoperative cardiac complications in current smokers (21.5%) and ex-smokers (20.5%) were not significantly different from the control group (28.2%). Also, pulmonary complications were not different in current smokers (24.7%) and ex-smokers (17.9%) from the control group (26.8%; P = 0.196). However, in men, pulmonary complications in current smokers were more prevalent than in the control group (P = 0.044). In opium and alcohol dependents and abusers, postoperative complications were not statistically different from the control group (all P values >0.05). No increase was observed regarding in-hospital mortality in patients with substance use. CONCLUSIONS: In cardiac surgery patients in northwest Iran, the prevalence of cigarette smoking is relatively low (very low in women), as is alcohol use, compared with Western countries; however, opium use is twice as prevalent. We found higher pulmonary complication rates in men who smoked, but no increase in postoperative cardiopulmonary complications and in-hospital mortality rates in patients who abused opium and consumed alcohol. (Anesth Analg 2009;109:1553-9)