Ivy N Haskins1, Richard Amdur, Khashayar Vaziri. 1. Department of Surgery, The George Washington University, 2150 Pennsylvania Ave., NW, Suite 6B, Washington, DC, 20037, USA, ihaskins@gwu.edu.
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.
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.
Authors: M Saetta; G Turato; S Baraldo; A Zanin; F Braccioni; C E Mapp; P Maestrelli; G Cavallesco; A Papi; L M Fabbri Journal: Am J Respir Crit Care Med Date: 2000-03 Impact factor: 21.405
Authors: Jonathan F Finks; Kerry L Kole; Panduranga R Yenumula; Wayne J English; Kevin R Krause; Arthur M Carlin; Jeffrey A Genaw; Mousumi Banerjee; John D Birkmeyer; Nancy J Birkmeyer Journal: Ann Surg Date: 2011-10 Impact factor: 12.969
Authors: Rafael Barrera; Weiji Shi; David Amar; Howard T Thaler; Natalie Gabovich; Manjit S Bains; Dorothy A White Journal: Chest Date: 2005-06 Impact factor: 9.410
Authors: Nancy J O Birkmeyer; Justin B Dimick; David Share; Abdelkader Hawasli; Wayne J English; Jeffrey Genaw; Jonathan F Finks; Arthur M Carlin; John D Birkmeyer Journal: JAMA Date: 2010-07-28 Impact factor: 56.272
Authors: Edward H Livingston; David Arterburn; Tracy L Schifftner; William G Henderson; Ralph G DePalma Journal: J Am Coll Surg Date: 2006-09-27 Impact factor: 6.113
Authors: David P Mason; Sreekumar Subramanian; Edward R Nowicki; Joshua D Grab; Sudish C Murthy; Thomas W Rice; Eugene H Blackstone Journal: Ann Thorac Surg Date: 2009-08 Impact factor: 4.330
Authors: Laura J Rasmussen-Torvik; Orna Reges; Philip Greenland; Dror Dicker; Morton Leibowitz; Adi Berliner Senderey; Moshe Hoshen; Ran D Balicer Journal: Obes Surg Date: 2019-12 Impact factor: 4.129
Authors: Andrea Balla; Gabriela Batista Rodríguez; Santiago Corradetti; Carmen Balagué; Sonia Fernández-Ananín; Eduard M Targarona Journal: Langenbecks Arch Surg Date: 2017-08-05 Impact factor: 3.445
Authors: Kamal K Mahawar; Chetan Parmar; William R J Carr; Neil Jennings; Norbert Schroeder; Shlok Balupuri; Peter K Small Journal: Obes Surg Date: 2015-08 Impact factor: 4.129
Authors: Tarik K Yuce; Rhami Khorfan; Nathaniel J Soper; Eric S Hungness; Alexander P Nagle; Ezra N Teitelbaum; Karl Y Bilimoria; David D Odell Journal: J Gastrointest Surg Date: 2019-12-17 Impact factor: 3.452
Authors: Paula J D Wolvers; Sjoerd C Bruin; Willem M Mairuhu; Monique de Leeuw-Terwijn; Barbara A Hutten; Dees P M Brandjes; Victor E A Gerdes Journal: Obes Surg Date: 2020-01 Impact factor: 4.129
Authors: Ivy N Haskins; Matthew D Kroh; Richard L Amdur; Jeffrey L Ponksy; John H Rodriguez; Khashayar Vaziri Journal: J Gastrointest Surg Date: 2017-07-25 Impact factor: 3.452