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Effect of patient-reported smoking status on short-term bariatric surgery outcomes

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Abstract

Introduction

Preoperative patient screening is a major contributor to the remarkable safety of bariatric surgery. Smoking status is a modifiable patient risk factor, and smoking cessation is associated with improved outcomes in surgical patients. However, the length of smoking cessation necessary to optimize bariatric surgery patient outcomes is not yet defined. We sought to explore the relationship between patient-reported smoking status and short-term bariatric surgery outcomes.

Methods

Using prospectively collected data from the MBSC registry, we evaluated the effects of patient-reported length of tobacco abstinence on 30-day surgical outcomes. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) patients (n = 49,772) were divided into three categories based on smoking status: never smoker, former smoker, and recent smoker. We compared risk-adjusted complication rates using multivariable logistic regression models and compared excess body weight loss using a one-way ANOVA test.

Results

The risk-adjusted rate of severe complications among RYGB patients in the recent smoker group was significantly increased relative to patients who had never smoked (OR 1.34; 95% CI, 1.01–1.77), but not among SG patients (OR 1.18; 95% CI 0.87–1.62). In the same populations, differences in overall complication rate were not significant for either RYGB (OR, 1.11; 95% CI 0.94–1.31) or LSG (OR 1.04; 95% CI 0.86–1.25).

Conclusions

Recent smokers suffer detrimental effects of smoking on serious postoperative complications following RYGB surgery, but may not suffer an elevated risk of complications attributable to smoking for sleeve gastrectomy. An evaluation of the effect on long-term outcomes is necessary to further define the risks of smoking on bariatric surgery outcomes.

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Funding

Dr. Ghaferi receives research funding from the Agency for Healthcare Research and Quality (K08 HS023621, P30 HS024403) and the Patient Centered Outcomes Research Institute (CE-1304-6596). He also receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative.

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Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Michael Inadomi, Rahul Iyengar, Ilana Fischer, Xing Chen & Emily Flagler

  2. Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA

    Amir A. Ghaferi

  3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Amir A. Ghaferi

  4. Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, NCRC Bldg 16, Rm140-E, Ann Arbor, MI, 48109, USA

    Amir A. Ghaferi

Authors
  1. Michael Inadomi
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  2. Rahul Iyengar
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  3. Ilana Fischer
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  4. Xing Chen
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  5. Emily Flagler
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  6. Amir A. Ghaferi
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Corresponding author

Correspondence to Amir A. Ghaferi.

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Disclosures

Mr. Michael Inadomi, Rahul Iyengar, Ms. Ilana Fischer, Xing Chen and Emily Flagler all have no conflicts of interest or financial ties to disclose.

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Inadomi, M., Iyengar, R., Fischer, I. et al. Effect of patient-reported smoking status on short-term bariatric surgery outcomes. Surg Endosc 32, 720–726 (2018). https://doi.org/10.1007/s00464-017-5728-1

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  • DOI: https://doi.org/10.1007/s00464-017-5728-1

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