Abstract
BACKGROUND: Chronic post-surgical pain (CPSP) brings health and financial burdens to patients and impairs quality of life after surgery. Smoking as a lifestyle factor plays an important role in management of chronic pain and its subtypes (e.g., CPSP). However, the impact of smoking on CPSP has not been fully elucidated due to limitations in smoking classification and the lack of secondhand smoke (SHS) exposure in previous studies. Therefore, this study aimed to comprehensively evaluate the association of current smoking and SHS exposure with the risk of CPSP. MATERIALS AND METHODS: We conducted a cohort study using UK Biobank participants who underwent surgery between 2006-2010 and 2019-2020. Participants were categorized into non-current smokers without SHS exposure, non-current smokers with SHS exposure, and current smokers. We used logistic regression models to assess the association of current smoking and SHS exposure with the risk of CPSP reporting odds ratios with 95% confidence intervals. Subgroup analyses stratified by sociodemographic variables (sex, ethnicity, education, and deprivation) were conducted. RESULTS: Of 97,821 participants, with a mean ± SD age of 56.5 ± 7.6 years, 3,509 (3.6%) reported CPSP. The risk of CPSP was significantly increased in non-current smokers with SHS exposure (4.6%, 1.30 [1.19-1.41]) and current smokers (4.8%, 1.37 [1.22-1.55]), compared with non-current smokers without SHS exposure (3.2%). The tendency for smoking to increase the risk of CPSP existed across all sociodemographic subgroups (e.g., males: 1.18 [1.04-1.35] in non-current smokers with SHS exposure and 1.35 [1.13 to 1.60] in current smokers; females: 1.39 [1.24-1.56] in non-current smokers with SHS exposure and 1.38 [1.16-1.64] in current smokers). CONCLUSION: SHS exposure may be as detrimental to the development of CPSP as being a current smoker.