Completion rates in a preoperative surgical weight loss program by tobacco use status

Published:February 10, 2017DOI:



      Weight loss surgery (WLS) is an effective treatment for obesity and its associated conditions, but given the known benefits of preoperative tobacco abstinence on reducing postoperative complications, many WLS programs require tobacco abstention before surgery.


      To evaluate the association between tobacco use and WLS program completion.


      A 548-bed university hospital in Pennsylvania with a nationally accredited comprehensive WLS program.


      A retrospective chart review was conducted to identify patients enrolled in a preoperative WLS program from January 1, 2013 to April 3, 2015. Participants were categorized as nontobacco users (NTU) or current tobacco users (CTU) based on self-report at assessment. Tobacco users were required to quit before scheduling surgery and abstinence was verified using serum cotinine (<7 ng/mL).


      A total 620 patients enrolled in the preoperative program; 16.7% were tobacco users, 89% of whom were cigarette smokers. A total of 57.4% (n = 356) completed the program overall and there was a significant difference in completion by tobacco use status (62.4% NTU completed versus 32.7% CTU, P<.001). Among those who dropped out, 54% did so after attending 2 visits. In addition to not using tobacco, female gender, white race, and no prior psychiatric treatment were significant predictors of program completion (all P values< .02).


      Current tobacco users dropped out of the preoperative program at almost twice the rate of nontobacco users. Weight loss surgery programs should offer evidence-based tobacco cessation interventions to improve access to care for obesity treatment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • U. S. Burden of Disease Collaborators
        The state of US health, 1990-2010: Burden of diseases, injuries, and risk factors.
        J Am Med Assoc. 2013; 310: 591-608
      1. U. S. Department of Health and Human Services. The health consequences of smoking: 50 years of progress, a report of the Surgeon General. Atlanta, GA; 2014.

        • Hu S.S.
        • Neff L.
        • Agaku I.T.
        • et al.
        Tobacco product use among adults - United States, 2013-2014.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 685-691
        • U. S. Department of Health Human Services
        Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.
        National Institutes of Health National Heart, Lung and Blood Institute. 1998;
        • Fryar C.
        • Carroll M.
        • Ogden C.
        Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2011-2012.
        NCHS Health E-Stats. 2014; : 1-6
        • Veldheer S.
        • Yingst J.
        • Zhu J.
        • Foulds J.
        Ten-year weight gain in smokers who quit, smokers who continued smoking and never smokers in the United States, NHANES 2003-2012.
        Int J Obes (Lond). 2015; 39: 1727-1732
        • Thun M.J.
        • Carter B.D.
        • Feskanich D.
        • et al.
        50-year trends in smoking-related mortality in the United States.
        N Engl J Med. 2013; 368: 351-364
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82
        • Freedman D.M.
        • Sigurdson A.J.
        • Rajaraman P.
        • Doody M.M.
        • Linet M.S.
        • Ron E.
        The mortality risk of smoking and obesity combined.
        Am J Prev Med. 2006; 31: 355-362
        • Ma J.
        • Jemal A.
        • Flanders W.D.
        • Ward E.M.
        Joint association of adiposity and smoking with mortality among U.S. adults.
        Prev Med. 2013; 56: 178-184
        • Buchwald H.
        • Avidor Y.
        • Braunwald E.
        • et al.
        Bariatric surgery: a systematic review and meta-analysis.
        JAMA. 2004; 292: 1724-1737
        • Obeid N.R.
        • Malick W.
        • Concors S.J.
        • Fielding G.A.
        • Kurian M.S.
        • Ren-Fielding C.J.
        Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data.
        Surg Obes Relat Dis. 2016; 12: 11-20
        • Haskins I.N.
        • Amdur R.
        • Vaziri K.
        The effect of smoking on bariatric surgical outcomes.
        Surg Endosc. 2014; 28: 3074-3080
        • Dayer-Jankechova A.
        • Fournier P.
        • Allemann P.
        • Suter M.
        Complications after laparoscopic Roux-en-Y gastric bypass in 1573 consecutive patients: are there predictors?.
        Obes Surg. 2016; 26: 12-20
        • Livingston E.H.
        • Arterburn D.
        • Schifftner T.L.
        • Henderson W.G.
        • DePalma R.G.
        National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes.
        J Am Coll Surg. 2006; 203: 625-633
        • Fiore M.C.
        Treating tobacco use and dependence: 2008 update. Clinical practice guideline.
        Department of health and Human Services. Public Health Service, Rockville, MD: U.S.2008
        • Anthonisen N.R.
        • Connett J.E.
        • Kiley J.P.
        • et al.
        Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1.
        The Lung Health Study. JAMA. 1994; 272: 1497-1505
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Diamant A.
        • Milner J.
        • Cleghorn M.
        • et al.
        Analysis of patient attrition in a publicly funded bariatric surgery program.
        J Am Coll Surg. 2014; 219: 1047-1055
        • Mechanick JI
        • Youdim A.
        • Jones D.B.
        • et al.
        Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.
        Obesity (Silver Spring). 2013; 21: S1-27
      2. Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev 2014;(3):CD002294.

        • Anthenelli R.M.
        • Benowitz N.L.
        • West R.
        • et al.
        Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial.
        Lancet. 2016; 387: 2507-2520