Effects of active smoking on postoperative outcomes in hospitalised patients undergoing elective surgery: a retrospective analysis of an administrative claims database in Japan.

OBJECTIVES: The purpose of this study was to investigate the effects of smoking on prognosis after elective surgeries. Incidence of 30-day postoperative complications was compared between propensity score-matched 'ever-smoker' and 'never-smoker' cohorts. Thirty-day mortality and medical costs during the hospital stay were also compared. DESIGN AND SETTING: A large-scale retrospective study using deidentified administrative claims data obtained from 372 acute care hospitals across Japan using the Diagnosis Procedure Combination system (ie, a flat-fee payment system). PARTICIPANTS: Inpatients who were hospitalised to undergo elective surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint of this study was incidence of 30-day postoperative complications. Secondary endpoints were 30-day mortality and total medical costs during hospitalisation. Comparison between ever-smokers and never-smokers was conducted using matched cohorts created by 1:1 propensity score matching. RESULTS: Using 561 598 eligible patients, matched ever-smoker and never-smoker cohorts (n=1 55 593 each) were created. Ever-smokers were defined as patients with Brinkman Index ≥1. The percentage of patients who were male was 76.7%, and mean ages for ever-smokers and never-smokers were 65.1±13.8 years old and 66.4±15.3 years old, respectively. The Brinkman Index of the ever-smoker cohort was 677.6±553.4. Smoking was significantly associated with higher risk of 30-day postoperative complications compared with not smoking (OR 1.15, 95% CI 1.13 to 1.17, p<0.001). Similarly, smoking was significantly associated with postoperative 30-day mortality, with OR of 1.22 (95% CI 1.08 to 1.39, p=0.002). CONCLUSIONS: Our results suggest that smoking could be associated with risk of poor postoperative outcomes. In particular, a history of smoking may increase the risk of 30-day postoperative complications as well as that of 30-day mortality. The results suggest that smoking might have a harmful effect on postoperative outcomes irrespective of types of surgery.

Qualitative Study on the Psychological Experiences of Trans-man and Trans-woman.

Transsexuals have problems associated with self and gender identities, as well as with their relationships with specialists such as doctor and counsellors. On the basis of the principle of interpretative phenomenological analysis, an exploratory research was carried out on self by studying the psychological experiences of participants and their relationships with specialists. Consequently the following needs of the transsexuals were identified: (1) understanding and alleviation of grief, conflict, and anxiety associated with gender dysphoria; (2) recovery and improvement of self-esteem; (3) support in real-life experiences and measures related to social and legal issues, such as coming out; and (4) necessity of information provision at medical institutions and among peers. To meet these needs, it was suggested that the specialists should (1) help recover their self-esteem through the exploration of their sexual identities and maintain and improve their quality of life and (2) provide comprehensive support to alleviate the grief caused by gender dysphoria. Such support will facilitate affirmative psychological experiences of transsexuals, which will require further attention in the form of clinical intervention.

The association between smoking cessation outpatient visits and total medical costs: a retrospective, observational analysis of Japanese employee-based public health insurance data.

AIMS: The short-term effects of smoking cessation (SC) on overall healthcare costs are unclear. This study aimed to compare the short-term medical costs between patients with SC outpatient visits (SCOVs) and those without SCOVs, consisting of SCOV itself and overall medical costs. MATERIALS AND METHODS: This study is a retrospective, observational study using a Japanese employee-based health insurance claims database (January 1, 2005-December 31, 2013). It analyzed individuals who were registered as smokers based on their medical checkup details. It compared the per-patient-per-year (PPPY) medical costs for male smokers who made ≥1 claim for SCOVs with those who made no claims. We also assessed whether the number of SCOVs by male and female smokers impacted medical costs. The Index Year was the year after the first SCOV claim and that after the first registration as a smoker (non-SCOV group). Medical costs were calculated using regression analysis and adjusted for baseline costs. RESULTS: In Index Year -1, PPPY medical costs for male smokers were ∼USD 323.01 (JPY 36,500, as of November 2017) higher in the SCOV (n = 5,608) vs the non-SCOV (n = 81,721) group; however, by Year 6 the costs were similar. From Year 4-6, PPPY medical costs for SCOVs were lower than those in the adjusted non-SCOV group. For 2,576 male and female smokers in the SCOV group, the average rates of increasing medical costs before and after the SCOV for 1, 2, 3, 4, and 5 SCOVs made were 58%, 44%, 50%, 41%, and 34%, respectively. LIMITATIONS: The database includes limited data on individuals >65 years. Only SCOVs based on claims data and not on other outcomes were assessed. CONCLUSIONS: Medical costs declined in the short-term following the first SCOV. Attendance at a greater number of SCOVs was associated with a lower increase ratio of medical costs.

Attitudes towards passive smoking at restaurants and effects of the provision of information: A comparison between smokers and non-smokers via a web survey.

Objectives　Our objectives were to conduct a web-based survey using adult participants to investigate 1) differences in attitudes towards smoking in the presence of non-smokers between smokers and non-smokers and 2) the potential impact of knowledge regarding the harmful effects of smoking and secondhand smoke (SHS) on smoker behavior in a restaurant.Method　Japanese smokers and non-smokers aged 20 to 69 were separately sampled and both groups were randomly allocated to either a knowledge group or a control group. The participants were asked to complete an online questionnaire to capture their attitudes and how they think they would behave in a restaurant where it was not clear whether smoking is prohibited or not. Data were analyzed using a t-test for numerical variables and a χ2 test for categorical variables. Logistic regression analysis was also conducted to elucidate the factors influencing the smoking behavior near non-smokers.Results　Overall, 2,157 participants were surveyed (smokers, n=1,084; non-smokers, n=1,073). Among smokers who intended to smoke in the restaurant, 24.8% answered that they would ask for permission from nearby persons before lighting up. However, only 2.8% of non-smokers had ever actually been asked for such permission. The percentage of smokers who would smoke in the restaurant was significantly lower in the knowledge group (16.4%) than the control group (22.8%). The most common reason for refraining from smoking was a lack of an ashtray on the table in both groups. Among the non-smokers, 37.4% of the knowledge group and 27.6% of the control group answered that they did not like nearby smoking. A multiple logistic regression analysis revealed that smoking in restaurants was significantly associated with nicotine dependence, household income, pregnancy, smoking place in the home, age, and SHS knowledge.Conclusion　This study suggested that most non-smokers do not inform smokers that they do not like nearby smoking. It was also found that smoking behaviors could be influenced by non-smokers' preference for nearby smoking and by environmental factors such as the presence of an ashtray on the table. Knowledge about the harmful effects of smoking and SHS may influence the attitudes and behavior towards nearby smoking among both smokers and non-smokers.

Examining the association of smoking with work productivity and associated costs in Japan.

AIMS: Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment. MATERIALS AND METHODS: The data source was the 2011 Japan National Health and Wellness Survey (n = 30,000). Respondents aged 20-64 were used in the analyses (n = 23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs. RESULTS: Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs. LIMITATIONS AND CONCLUSIONS: Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers. This report highlights the workplace benefits of smoking cessation across productivity markers and cost-savings.

Cost-Effectiveness Analysis of Smoking Cessation Interventions in Japan Using a Discrete-Event Simulation.

BACKGROUND: Smoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common. OBJECTIVE: The objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used. METHODS: A discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen). RESULTS: Using pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates. CONCLUSIONS: Increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.