The Effect of Smoking on Open and Laparoscopic Bariatric Outcomes

Ivy N Haskins, MD, Richard Amdur, PhD, Khashayar Vaziri, MD, FACS. George Washington University Department of General Surgery.

Background: Bariatric surgery is an effective long-term treatment for morbid obesity. Although the effect of smoking on bariatric surgical outcomes is unclear, many bariatric surgeons recommend smoking cessation prior to surgery. We investigated the association of smoking on adverse bariatric surgical outcomes using the National Surgical Quality Improvement Program Database (NSQIP).

Methods and Procedures: Bariatric patients were identified in NSQIP using Current Procedure Terminology Codes (CPT) for all types of bariatric procedures except adjustable gastric banding. Pre-treatment variables’ univariate associations with smoking were examined using chi-square regression and t-tests. Association of smoking with outcomes, corrected for relevant covariates, were tested with logistic regression within laparoscopic and open treatment groups.

Results: 41,445 patients underwent gastric bypass surgery (35,696 laparoscopic; 5,749 open). Table 1 depicts outcomes for smokers and non-smokers who have undergone laparoscopic and open bariatric surgery. Smokers had a significantly increased risk of re-intubation, sepsis, septic shock, and length of stay greater than one week in laparoscopic bariatric surgery when compared to nonsmokers. In open bariatric procedures, smoking was significantly associated with pneumonia, prolonged intubation, organ space infection, and length of stay greater than one week.

Conclusions: These data suggest that smoking is a modifiable preoperative risk factor that leads to increased pulmonary morbidity and length of hospital stay for all types of bariatric surgery. Smoking also increases the risk of organ space (intra-abdominal) infection in open bariatric surgery. Smoking cessation should be encouraged in order to minimize the risk of adverse outcomes. Future investigations are needed to identify the optimal length of cessation.

Table 1: Effect of Smoking on Laparoscopic and Open Bariatric Surgery

Laparoscopic Bariatric Surgery

n = 35, 696

Open Bariatric Surgery

n = 5, 749

OutcomepOdds Ratio (95% CI)*p Odds Ratio (95% CI)
Pneumonia.141.35 (0.91 – 2.00) <0.0013.06 (1.95 – 4.80)
Re-Intubation.041.61 (1.02 – 2.54).271.44 (.076 – 2.72)
Prolonged Intubation.051.63 (1.01 – 2.64).012.14 (1.21 – 3.80)
Organ Space Infection.101.35 (0.94 – 1.92).031.79 (1.07 – 3.00)
Sepsis.041.44 (1.02 – 2.03).20 1.45 (0.82 – 2.57)
Septic Shock.021.96 (1.14 – 3.36).191.59 (0.79 – 3.19)
LOS > 7 Days.051.29 (1.00 -1.66).031.47 (1.04 – 2.08)

 *Odds ratios are expressed in comparison to nonsmokers for each group respectively.


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