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Impact of smoking on disease phenotype and postoperative outcomes for Crohn’s disease patients undergoing surgery

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Abstract

Aim

Whether smoking affects disease distribution, phenotype, and perioperative outcomes for Crohn’s disease (CD) patients undergoing surgery is not well characterized. The aim of this study is to evaluate the impact of smoking on disease phenotype and postoperative outcomes for CD patients undergoing surgery

Methods

Prospectively collected data of CD patients undergoing colorectal resection were evaluated. CD patients who were current smokers (CS) were compared to nonsmokers (NS) and ex-smokers (ES) for disease phenotype, anatomic site involved, procedures performed, postoperative outcomes, and quality of life using the Cleveland Global Quality of Life instrument (CGQL).

Results

Of 691 patients with a diagnosis of CD requiring surgery 314 were classified as CS, 330 as NS, and 47 as ES. CS and ES in comparison to NS were significantly older at diagnosis of Crohn’s disease (mean, 29.3 vs. 29.2 vs. 26.3 years) (P = 0.001) and older at the time of primary surgery (mean, 42.9 vs. 48.4 vs. 39 years) (P = 0.001) with a greater frequency of diabetes. In all groups requiring surgery, there was a significant change in disease phenotype from the time of diagnosis to surgical intervention. The predominant phenotype at diagnosis was inflammatory which changed to stricturing and penetrating as the dominant phenotypes at time of surgery. All groups had a significant improvement in CGQL scores post-surgery with the greatest benefit observed in NS. Postoperative complications and 30-day readmission rates were similar between all groups.

Conclusions

The findings of this study show that in patients with CD, disease phenotype changes over time. This occurs independent of smoking. Smoking does not appear to predispose to complications for CD patients undergoing surgery. CS and ES have a persistently reduced quality of life in comparison to NS post-surgery.

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References

  1. Rubin DT, Hanauer SB (2000) Smoking and inflammatory bowel disease. Eur J Gastroenterol Hepatol 12:855–862

    Article  PubMed  CAS  Google Scholar 

  2. Langholz E (2010) Current trends in inflammatory bowel disease. Therap Adv Gastroenterol 3:77–86

    Article  PubMed  Google Scholar 

  3. Thomas GA, Rhodes J, Green JT, Richardson C (2000) Role of smoking in inflammatory bowel disease: implications for therapy. Postgrad Med J 76:273–279

    Article  PubMed  CAS  Google Scholar 

  4. Picco MF, Bayless TM (2003) Tobacco consumption and disease duration are associated with fistulizing and stricturing behaviors in the first 8 years of Crohn’s disease. Am J Gastroenterol 98:363–368

    Article  PubMed  Google Scholar 

  5. Kane SV, Flicker M, Katz-Nelson F (2005) Tobacco use is associated with accelerated clinical recurrence of Crohn’s disease after surgically induced remission. J Clin Gastroenterol 39:32–35

    PubMed  Google Scholar 

  6. Moller AM, Villebro N, Pedersen T, Tonnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 359:114–117

    Article  PubMed  Google Scholar 

  7. Yamamoto T (2005) Factors affecting recurrence after surgery for Crohn’s disease. World J Gastroenterol 11:3971–3979

    PubMed  Google Scholar 

  8. Delgado-Rodriguez M, Medina-Cuadros M, Martinez-Gallego G et al (2003) A prospective study of tobacco smoking as a predictor of complications in general surgery. Infect Control Hosp Epidemiol 24:37–43

    Article  PubMed  Google Scholar 

  9. Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT (2005) Predictors of wound infection in ventral hernia repair. Am J Surg 190:676–681

    Article  PubMed  Google Scholar 

  10. Kiran RP, Delaney CP, Senagore AJ et al (2003) Prospective assessment of Cleveland Global Quality of Life and disease activity in Crohn’s disease. Am J Gastroenterol 98:1783–1789

    Article  PubMed  Google Scholar 

  11. Fazio VW, O’Riordain MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–586

    Article  PubMed  CAS  Google Scholar 

  12. Sorensen LT, Karlsmark T, Gottrup F (2003) Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 238:1–5

    PubMed  Google Scholar 

  13. Moller A, Tonnesen H (2006) Risk reduction: perioperative smoking intervention. Best Pract Res Clin Anaesthesiol 20:237–248

    Article  PubMed  Google Scholar 

  14. Theadom A, Cropley M (2006) Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review. Tob Control 15:352–358

    Article  PubMed  Google Scholar 

  15. Avidan B, Sakhnini E, Lahat A et al (2005) Risk factors regarding the need for a second operation in patients with Crohn’s disease. Digestion 72:248–253

    Article  PubMed  CAS  Google Scholar 

  16. Lindeberg E, Jarnerot G, Huitfeldt (1992) Smoking in Crohn’s disease:effect on localization and clinical course. Gut 33:779–782

    Article  Google Scholar 

  17. Yamamoto T, Kneighley RB (1999) The association of cigarette smoking with a high risk of recurrence after ileocolic resection for ileocecal Crohn’s disease. Surg Today 29:579–580

    Article  PubMed  CAS  Google Scholar 

  18. Ford AC, Sandbom WJ, Khan KJ et al (2011) Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 106:644–659

    Article  PubMed  CAS  Google Scholar 

  19. Canavan C, Abrams KR, Mayberry JF (2007) Meta-analysis: mortality in Crohn’s disease. Aliment Pharmacol Ther 25:861–870

    Article  PubMed  CAS  Google Scholar 

  20. Lakatos PL, Czegledi Z, Szamosi T et al (2009) Perianal disease, small bowel disease, smoking, prior steroid or azathioprine/biological therapy are predictors of disease change in patients with Crohn’s disease. World J Gastroenterol 15:3505–3510

    Google Scholar 

  21. Louis E, Collard A, Oger AF et al (2001) Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut 49:777–782

    Article  PubMed  CAS  Google Scholar 

  22. Chow DK, Leong RW, Lai LH et al (2008) Changes in Crohn’s disease phenotype over time in the Chinese population: validation of the Montreal classification system. Inflamm Bowel Dis 14:536–541

    Article  PubMed  Google Scholar 

  23. Hongyan C, Alexander L, Bowcock A et al (2011) Influence of Crohn’s disease risk alleles and smoking on disease location. Dis Colon Rectum 54:1020–1025

    Article  Google Scholar 

  24. Tamas S, Janos B, Lakatos L et al (2010) Early azathioprine/biological therapy is associated with decreased risk for first surgery and delays to time to surgery but not reoperation in both smokers and nonsmokers with Crohn’s disease, while smoking decreases the risk of colectomy in ulcerative colitis. Eur J Gastroenterol Hepatol 22:872–879

    Article  Google Scholar 

  25. Sunyoung P, Do-Hoon L, Jae-Gahb P, Young T (2010) A sensitive enzyme immunoassay for measuring cotinine in passive smokers. Clinica Chimica Acta 411:1238–1242

    Article  Google Scholar 

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Acknowledgments

The authors thank Jeffrey P. Hammell for help with the study design and statistics.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A-30, Cleveland, OH, 44195, USA

    Myles R. Joyce, Christine D. Hannaway, Scott A. Strong, Victor W. Fazio & Ravi P. Kiran

Authors
  1. Myles R. Joyce
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  2. Christine D. Hannaway
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  3. Scott A. Strong
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  4. Victor W. Fazio
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  5. Ravi P. Kiran
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Corresponding author

Correspondence to Ravi P. Kiran.

Additional information

Poster presentation at American Society of Colon and Rectal Surgeons Tripartite Meeting, 7–12 June, 2008, Boston, MA

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Joyce, M.R., Hannaway, C.D., Strong, S.A. et al. Impact of smoking on disease phenotype and postoperative outcomes for Crohn’s disease patients undergoing surgery. Langenbecks Arch Surg 398, 39–45 (2013). https://doi.org/10.1007/s00423-011-0865-9

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  • DOI: https://doi.org/10.1007/s00423-011-0865-9

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