Jingliang Yan, MD, PhD, Brandon Williams, MD, Matthew Spann, MD, Chetan Aher, MD, Wayne English, MD. Vanderbilt University Medical Center
Introduction: Bariatric surgery is an effective means of achieving weight loss and improvement of metabolic co-morbidities. Enhancing quality and safety profile is imperative as the number of bariatric procedures increases worldwide. Smoking has been associated with increased postoperative complications after many surgical procedures. We aim to study how preoperative smoking status affects postoperative outcomes in bariatric patients using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
Methods and Procedures: Patients in the MBSAQIP 2016 data registry undergoing elective bariatric procedures were identified and included. Odds ratio (OR) and 95% confidence interval (CI) of postoperative complications in recent smokers compared to non-smokers were calculated.
Results: A total of 184,749 patients undergoing elective bariatric surgery in 2016 were identified. Of these patients, 16,084 (8.6%) reported smoking cigarettes within 1 year prior to the bariatric operations. Length of stay was slightly longer in patients with a smoking history (1.8 vs 1.7 days). Several postoperative complication rates were increased with smoking. Unplanned re-intubation (OR=1.70, CI 1.23-2.34), Clostridium difficile infection (OR=1.64, CI 1.15-2.33), postoperative incisional hernia (OR=1.62, CI 1.02-2.55), and 30-day mortality related to the operation (OR=1.80, CI 1.02-3.18) were associated with an odds ratio of at least 1.5. In addition, intraoperative or postoperative transfusion requirement (OR=1.20, CI 1.00-1.44), unplanned ICU admission (OR=1.34, CI 1.12-1.58), 30-day reoperation (OR=1.23, CI 1.08-1.39), 30-day readmission (OR=1.16, CI 1.07-1.25), and need for intervention within 30 days (OR=1.25, CI 1.10-1.40) were associated with an odds ratio of greater than 1.
Conclusion: Prior smoking history within a year of bariatric surgery is associated with an increase in multiple postoperative complications as well as mortality. Smoking cessation therefore may improve outcomes among bariatric patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94143
Program Number: P058
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster