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Smoking and bariatric surgery do not mix

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SAN DIEGO — Individuals who actively smoked experienced worse outcomes after bariatric surgery, including death and serious morbidity, according to data presented at Digestive Disease Week.

Tarik Yuce, MD, of the department of surgery at Northwestern Memorial Hospital, said bariatric surgery has become safer because of the intense preoperative evaluation and preparation that comes before it.

“However, areas for improvement remain,” Yuce said in his presentation. “In particular, smoking represents a key risk factor for poor outcomes following general surgery procedures, but less is known about the impact of smoking on this completely elective patient population.”

Yuce and colleagues analyzed data from the American College of Surgeons National Surgical Quality Improvement Program database to evaluate the risk for 30-day postoperative complications and readmission in patients who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-En-Y gastric bypass (LRYGB) between 2012 to 2017. They compared those outcomes based on smoking status, defined as patient self-report of smoking within the year before surgery.

The investigators identified 12,424 active smokers (9.3%) among a total cohort of 133,417 patients. Compared with non-smokers, more smokers experienced death or serious morbidity (3.8% vs. 3.4%; P = .019), readmission (4.9% vs. 4.1%; P < .001), superficial (1.2% vs. 0.8%; P < .001) and organ space surgical site infection (0.7% vs. 0.5%; P = .001), as well as respiratory complications like pneumonia, reintubation and failure to wean from mechanical ventilation. There was no significant difference in outcomes between patients who underwent LSG and LRYGB.

Data showed that active smokers were more likely to experience death or serious morbidity (OR = 1.13; 95% CI, 1.01–1.26), readmission (OR = 1.21; 95% CI, 1.1–1.33), wound complications (OR = 1.44; 95% CI, 1.24–1.68) and respiratory complications (OR = 1.69; 95% CI, 1.34–2.14) compared with non-smokers.

Yuce said the association between smoking and worse outcomes after bariatric surgery showed how important smoking cessation counseling is in this patient population.

“The rigorous preoperative evaluation for bariatric surgery presents a unique opportunity to capture a teachable moment,” he said. “These patients are plugged into a rather intense evaluation process. They’re seeing several different providers, including physicians, the surgeons themselves, dieticians and psychologists. So, these patients are truly primed to intervene on.” – by Alex Young

Reference:

Yuce T, et al. Abstract 558. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Yuce reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.