LAUSR

ABSTRACT Background: Smoking may offer pathophysiologic adaptations that increase survivability in certain patients with cardiovascular disease. We sought to identify if smoking increases survivability in trauma patients, hypothesizing that critically ill trauma patients who smoke have a decreased risk of mortality compared with non-smokers. Methods: The Trauma Quality Improvement Program (2010-2016) database was queried for trauma patients with intensive care unit admissions. A multivariable logistic regression model was performed. Results: From the 630,278 critically ill trauma patients identified, 116,068 (18.4%) were current cigarette smokers. Critically ill trauma smokers, compared with non-smokers, had a higher rate of pneumonia (7.8% vs. 6.9%, P< 0.001) and lower mortality rate (4.0% vs. 8.0%, P< 0.001). After controlling for covariates, smokers had a decreased associated risk of mortality compared with non-smokers (OR = 0.55, CI = 0.51-0.60, P< 0.001), and no difference in the risk of major complications (OR = 0.98, CI = 0.931.03, P = 0.44). The same analysis was performed using age as a continuous variable with associated decreased risk of mortality (OR 0.57 (CI 0.53–0.62), P< 0.001). Conclusion: Critically ill trauma smokers had a decreased associated mortality risk compared with non-smokers possibly due to biologic adaptations such as increased oxygen delivery developed from smoking. Future basic science and translational studies are needed to pursue potential novel therapeutic benefits without the deleterious long-term side effects of smoking.