Skip to main content

Advertisement

SpringerLink
Log in

The effect of smoking on bariatric surgical outcomes

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery is an effective long-term treatment for morbid obesity. Although smoking is known to increase postoperative complications, the independent effect of smoking on bariatric surgical outcomes is unclear. The purpose of this study was to investigate the effect of smoking on bariatric surgical outcomes using the National Surgical Quality Improvement Program (NSQIP).

Study design

Bariatric patients from 2005 to 2010 were identified in NSQIP for all types of bariatric procedures except adjustable gastric banding. Pre-treatment variables’ univariate associations with smoking were examined with chi-square and t tests. Association of smoking with outcomes, corrected for relevant covariates, was tested with logistic regression within laparoscopic and open treatment groups.

Results

A total of 41,445 patients underwent bariatric surgery (35,696 laparoscopic; 5,749 open). After controlling for covariates, smoking significantly increased the risk of organ space infection, prolonged intubation, reintubation, pneumonia, sepsis, shock, and longer length of stay in all patients undergoing bariatric surgery. In the open bariatric surgery subgroup, smoking was associated with a significantly higher incidence of organ space infection, prolonged intubation, pneumonia, and length of stay. In the laparoscopic surgery subgroup, smokers had a significantly increased incidence of prolonged intubation, reintubation, sepsis, shock, and length of stay. Smoking did not significantly increase the risk of mortality for patients undergoing bariatric surgery.

Conclusions

These data suggest that smoking is a modifiable preoperative risk factor that significantly increases the incidence of postoperative morbidity but not mortality in both laparoscopic and open bariatric surgery. Smoking cessation may minimize the risk of adverse outcomes. Future investigation is needed to identify the optimal length of preoperative smoking cessation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finks J, Kole K, Yenumula P et al (2011) Predicting risks for serious complications with bariatric surgery: results from the Michigan bariatric surgery collaborative. Ann Surg 254(4):633–638

    Article  PubMed  Google Scholar 

  2. Encinosa W, Bernard D, Du D et al (2009) Recent improvements in bariatric surgery outcomes. Med Care 47:531–535

    Article  PubMed  Google Scholar 

  3. Birkmeyer N, Dimick J, Share D et al (2010) Hospital complication rates with bariatric surgery in Michigan. J Am Med Assoc 304:435–442

    Article  CAS  Google Scholar 

  4. Flum D, Belle S, King W et al (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454

    Article  PubMed  Google Scholar 

  5. NSQIP History. ACS NSQIP Website. http://site.acsnsqip.org/program-specifics/nsqip-history/. Accessed June 11, 2013

  6. Morton H (1944) Tobacco smoking and pulmonary complications after operation. Lancet 4:368–370

    Article  Google Scholar 

  7. 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. Tobacco Control 15:352–358

    Article  PubMed  PubMed Central  Google Scholar 

  8. Livingston E, Arterburn D, Schifftner T et al (2006) National surgical quality improvement program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg 203:625–633

    Article  PubMed  Google Scholar 

  9. Masoomi H, Reavis K, Smith B et al (2013) Risk factors for acute respiratory failure in bariatric surgery: data from the nationwide inpatient sample, 2006–2008. Surg Obes Other Relat Dis 9(2):277–281

    Article  Google Scholar 

  10. Masoomi H, Kim H, Reavis K et al (2011) Analysis of factors predictive of gastrointestinal tract leak in laparoscopic and open gastric bypass. Arch Surg 146(9):1048–1051

    Article  PubMed  Google Scholar 

  11. Froehling D, Daniels P, Mauck K, et al (2013) Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. J Metabolic Surg All Care. Retrieved September 16, 2013: http://link.springer.com.proxygw.wrlc.org/article/10.1007%2Fs11695-013-1073-1/fulltext.html

  12. Khullar D, Maa J (2012) The impact of smoking on surgical outcomes. J Am Coll Surg 215(3):418–426

    Article  PubMed  Google Scholar 

  13. Krueger K, Rohrich R (2001) Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery. Plast Reconstr Surg 108:1063–1077

    Article  PubMed  CAS  Google Scholar 

  14. Townsend C (2012) Wound healing in Sabiston textbook of surgery: the biological basis of modern surgical practice, 19th ed. Saunders, Philadelphia, PA

  15. Chang L, Buncke G, Slezak S et al (1996) Cigarette smoking, plastic surgery, and microsurgery. J Reconstr Microsurg 12(7):467–474

    Article  PubMed  CAS  Google Scholar 

  16. Riefkohl R, Wolfe J, Cox E et al (1986) Association between cutaneous occlusive vascular disease, cigarette smoking, and skin slough after rhytidectomy. Plast Reconstr Surg 77:592

    Article  PubMed  CAS  Google Scholar 

  17. Saetta M, Turato G, Baraldo S et al (2000) Goblet cell hyperplasia and epithelial inflammation in peripheral airways of smokers with both symptoms of chronic bronchitis and chronic airflow limitation. Am J Respir Crit Care Med 16(3):1016–1021

    Article  Google Scholar 

  18. Garey K, Neuhauser N, Robbins R et al (2004) Markers of inflammation in exhaled breath condensate of young healthy smokers. Chest 125:415–420

    Article  Google Scholar 

  19. Lensmar C, Elmberger G, Skold M et al (1998) Smoking alters the phenotype of macrophages in induced sputum. Respir Med 92(3):415–420

    Article  PubMed  CAS  Google Scholar 

  20. Dimick J, Chen S, Taheri P et al (2004) Hospital costs associated with surgical complications: a report from the private-sector national surgical quality improvement program. J Am Coll Surg 199(4):531–537

    Article  PubMed  Google Scholar 

  21. Mason DP, Subramanian S, Nowicki ER et al (2009) Impact of smoking cessation before resection of lung cancer: a society of thoracic surgeons general thoracic surgery database study. Ann Thorac Surg 88:362–371

    Article  PubMed  Google Scholar 

  22. Bluman LG, Mosca L, Newman N et al (1998) Preoperative smoking habits and postoperative pulmonary complications. Chest 113(4):883–889

    Article  PubMed  CAS  Google Scholar 

  23. Moller AM, Villebro N, Pederson T et al (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinic trial. Lancet 359:114–117

    Article  PubMed  Google Scholar 

  24. Barrera R, Shi W, Thaler HT et al (2005) Smoking and timing of cessation: impact on pulmonary complications after thoracotomy. Chest 127(6):1977–1983

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, The George Washington University, 2150 Pennsylvania Ave., NW, Suite 6B, Washington, DC, 20037, USA

    Ivy N. Haskins, Richard Amdur & Khashayar Vaziri

Authors
  1. Ivy N. Haskins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Amdur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khashayar Vaziri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivy N. Haskins.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haskins, I.N., Amdur, R. & Vaziri, K. The effect of smoking on bariatric surgical outcomes. Surg Endosc 28, 3074–3080 (2014). https://doi.org/10.1007/s00464-014-3581-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3581-z

Keywords

Search

Navigation