Study author | Year | Outcome methodology | Age group (identified/included) | Surgical group | Location | ETS measure (number exposed) | ETS priority | Outcomes | Quality score |
---|---|---|---|---|---|---|---|---|---|
Drongowski14 | 2003 | Prospective cohort | 3 months–13 years (n=146/146) | Inguinal hernia repair | USA | Parent questionnaire on smoking history/exposure and urinary cotinine (57 ETS+) | 1° | Observed respiratory events in induction, emergence and recovery | 8 |
Jones15 | 2006 | Prospective cohort | 1–18 years (n=428/405) | Elective day case: mixed specialties | USA | Parent completed risk factor questionnaire, included smoking history (168 ETS+) | 1° | Airway complications observed against graded scale intraoperatively and post anaesthesia | 7 |
Kim16 | 2013 | Retrospective cohort | Child: not defined (n=159/159) | Had URI symptom; ENT and ophthalmology | South Korea | Passive smoking documented in anaesthetic record (28 ETS+) | 1° | Respiratory adverse events documented in notes at intubation, intra-extubation and post-extubation, and in recovery | 7 |
Lakshmipathy17 | 1996 | Retrospective cohort | Child: not defined (n=322/310) | Elective day case: ENT and urology | USA | Parent reported regular smoker at home (96 ETS+) | 1° | Laryngospasm documented in records | 7 |
Lyons18 | 1996 | Prospective cohort | 1–12 years (n=?/125) | Elective day case: not ENT | Ireland | Parental questionnaire of home and other smoker contacts (63 ETS+) | 1° | Respiratory adverse events observed by blinded anaesthetist at preoperative, intraoperative and postoperative points | 6 |
Mamie19 | 2004 | Prospective cohort | 1–14 years (n=800/743) | Mixed specialties | Switzerland | Parent completed allergy/ asthma questionnaire, including smoking (429 ETS+) | 2° | Intraoperative, postoperative and perioperative respiratory adverse events | 7 |
O'Rourke20 | 2006 | Prospective matched cohort | 5–15 years (n=93 at recovery; 96 at discharge) | Convenience sample; non-cavity surgery | USA | Direct parental questioning (46 ETS+ at recovery, 49 ETS+ at discharge) | 1° | Pulmonary function as percentage predicted; respiratory events secondary outcome | 7 |
Parnis41 | 2011 | Prospective case–control | Child: not defined* (n=?/2051) | Mixed specialties | Australia | Parental smoking status as part of wider research questionnaire (926 ETS+) | 2° | ‘Good’ vs ‘bad’ anaesthetic outcome, including adverse respiratory, gastrointestinal and circulatory events | 6 |
Reisli21 | 2004 | Prospective cohort | 4–10 years (n=40/40) | ENT surgery; convenience sample | Turkey | Parental questioning of child's overall ETS exposure (20 ETS+) | 1° | Rocuronium dose required for neuromuscular blockade | 6 |
Seyidov22 | 2011 | Prospective cohort | 3 months–12 years (n=402†/385) | Elective surgery | Turkey | Parent questioning of quantity of smoke exposure (234 ETS+) | 1° | Respiratory adverse events observed by blinded team | 7 |
Skolnick23 | 1998 | Prospective cohort | 1 month–12 years (n=602/499) | Elective surgery | USA | Urinary cotinine and parental enquiry (262 ETS+) | 1° | Respiratory adverse events | 8 |
Tait24 | 2001 | Prospective cohort | 1 month–18 years (n=1078/407) | Elective surgery with active URI | USA | Questionnaire including parental smoking habits | 2° | Contribution of factor to overall predictive multiple regression model | 6 |
Thikkurissy25 | 2012 | Prospective cohort | 19 months–12 years (n=?/99) | Dental | USA | Parental interview on smoking status and quantity (51 ETS+) | 1° | Respiratory adverse events observed by blinded anaesthetist and recovery nurse | 7 |
Tütüncü26 | 2011 | Prospective cohort | 1–15 years (n=?/150) | Convenience sample; lower abdominal/urology | Turkey | Parental questionnaire including parent smoking status (100 ETS+) | 1° | Secondary outcome of postoperative respiratory complications | 5 |
von Ungern-Sternberg et al27 | 2010 | Prospective cohort | Child: not defined (n=10496/9038) | Anaesthesia for elective and urgent | Australia | Parent smoking report at preoperation check (2929 ETS+) | 1° | Perioperative adverse events | 8 |
*Study age range from 0 to 22 years. Mean age 5.8. Reviewers made decision to include in study.
†There is an apparent numerical error in the original paper where the identified total appears not to include exclusions.
ENT, ear, nose and throat; ETS, environmental tobacco smoke; URI, upper respiratory infection.