Advertisement

Should recent smoking be a contraindication for sleeve gastrectomy?

      Abstract

      Background

      One of the ultimate goals of bariatric and metabolic surgery is to decrease cardiovascular morbidity and mortality. Obese individuals who smoke tobacco are at an increased risk of cardiovascular events and may benefit the most by positive effects of bariatric surgery on cardiometabolic risk factors. The safety profile of sleeve gastrectomy in patients who smoke has not yet been characterized.

      Objectives

      To investigate the independent effect of smoking on early postoperative morbidity and mortality of laparoscopic sleeve gastrectomy.

      Setting

      American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

      Methods

      All patients undergoing primary laparoscopic sleeve gastrectomy from 2010 to 2014 were identified within the NSQIP database. Thirty-day postoperative outcomes for smokers, defined as patients who smoked within the year before surgery, were compared with nonsmokers.

      Results

      A total of 33,714 people underwent sleeve gastrectomy; 30,418 (90.2%) patients were nonsmokers, whereas 3296 (9.8%) patients smoked within a year before surgery. Among the 17 examined individual adverse events, patients who smoked were more likely to experience an unplanned reintubation (odds ratio [OR] = 1.88, 95% confidence interval [CI]: 1.01–3.50). Patients in the smoking group were significantly more likely to experience a composite morbidity event (4.3% versus 3.7%, P = .04), serious morbidity event (.9% versus .6%, P = .003), and 30-day mortality (0.2% versus .1%, P = .0004). The length of hospital stay, unplanned readmission, and readmission rates were comparable between the 2 groups. These differences in the composite morbidity event, serious morbidity event, and mortality persisted even when those patients with chronic obstructive pulmonary disease, used as a surrogate for end-stage pulmonary effects of smoking, were excluded from the analysis.

      Conclusion

      Sleeve gastrectomy is a well-tolerated procedure in nonsmokers and smokers. However, patients who have smoked within a year before sleeve gastrectomy are at an increased, albeit still very low, risk for 30-day morbidity and mortality compared with nonsmokers. Additional studies are needed to determine if long-term improvement in co-morbidities can offset this initial modest increased perioperative risk.

      Keywords

      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:

      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

      References

        • World Health Organization
        Obesity and Overweight Facts Sheet [monograph on the Internet].
        World Health Organization, Geneva, Switzerland2015 ([cited 2016 Oct 29]. Available from:)
        • Finkelstein E.A.
        • Khavjou O.A.
        • Thompson H.
        • et al.
        Obesity and severe obesity forecasts through 2030.
        Am J Prev Med. 2012; 42: 563-570
        • Soler R.
        • Orenstein D.
        • Honeycutt A.
        • et al.
        Community-based interventions to decrease obesity and tobacco exposure and reduce health care costs: Outcome estimates from communities putting prevention to work from 2010-2020.
        Prev Chronic Dis. 2016; 13: E47
        • Aminian A.
        • Brethauer S.A.
        • Andalib A.
        • et al.
        Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes.
        Ann Surg. 2016; 264: 674-681
        • Aminian A.
        • Andalib A.
        • Khorgami Z.
        • et al.
        A nationwide safety analysis of bariatric surgery in nonseverely obese patients with type 2 diabetes.
        Surg Obes Relat Dis. 2016; 12: 1163-1170
        • Kirwan J.P.
        • Aminian A.
        • Kashyap S.R.
        • Burguera B.
        • Brethauer S.A.
        • Schauer P.R.
        Bariatric surgery in obese patients with type 1 diabetes.
        Diabetes Care. 2016; 39: 941-948
        • Aminian A.
        • Zelisko A.
        • Kirwan J.P.
        • Brethauer S.A.
        • Schauer P.R.
        Exploring the impact of bariatric surgery on high density lipoprotein.
        Surg Obes Relat Dis. 2015; 11: 238-247
        • Schauer P.R.
        • Bhatt D.L.
        • Kirwan J.P.
        • et al.
        Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes.
        N Engl J Med. 2014; 37: 2002-2013
        • Centers for Disease Control and Prevention (CDC)
        Burden of tobacco in the U.S. [monograph on the Internet].
        CDC, Atlanta, GA2016 ([cited 2016 Oct 29]. Available from:)
        • Wee C.C.
        • Phillips R.S.
        • Legedza A.T.R.
        • et al.
        Health care expenditures associated with overweight and obesity among US adults: importance of age and race.
        Am J Public Health. 2005; 95: 159-165
        • Gupta P.K.
        • Gupta H.
        • Kaushik M.
        • et al.
        Predictors of pulmonary complications after bariatric surgery.
        Surg Obes Relat Dis. 2012; 8: 574-581
        • Felix E.L.
        • Kettelle J.
        • Mobley E.
        • Swartz D.
        Perforated marginal ulcers after laparoscopic gastric bypass.
        Surg Endosc. 2008; 22: 2128-2132
        • Haskins I.N.
        • Amdur R.
        • Vaziri K.
        The effect of smoking on bariatric surgical outcomes.
        Surg Endosc. 2014; 28: 3074-3080
        • Moon R.C.
        • Teixerira A.F.
        • Glodbach M.
        • Jawad M.
        Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume institution.
        Surg Obes Relat Dis. 2014; 10: 229-234
        • Patel R.A.
        • Brolin R.E.
        • Gandhi A.
        Revisional operations for marginal ulcer after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2009; 5: 317-322
        • American College of Surgeons (ACS)
        ACS-NSQIP Participant Use Data File [closed database on the Internet].
        ACS, Chicago, IL19962017 ([cited 2016 Nov 8]. Available from)
        • Dindo D.
        • Demartines S.
        • Clavien P.A.
        Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Serapinas D.
        • Narbekovas A.
        • Juskevicius J.
        • Sakalauskas R.
        Systemic inflammation in COPD in relation to smoking status.
        Multidiscp Respir Med. 2011; 6: 214-219
        • Williamse B.W.M.
        • ten Hacken N.H.T.
        • Rutgers B.
        • Postma D.S.
        • Timens W.
        Association of current smoking with airway inflammation in chronic obstructive pulmonary disease and asymptomatic smokers.
        Respir Res. 2005; 6: 38
        • Aminian A.
        • Brethauer S.A.
        • Sharafkhah M.
        • Schauer P.R.
        Development of a sleeve gastrectomy risk calculator.
        Surg Obes Relat Dis. 2015; 11: 758-764
        • Hickey M.S.
        • Pories W.J.
        • MacDonald K.G.
        • Cory K.A.
        • Dohm G.L.
        • Swanson M.S.
        A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut?.
        Ann Surg. 1998; 227: 637-644
        • Morton H.J.V.
        • Camb D.A.
        Tobacco smoking and pulmonary complications after operation.
        Lancet. 1944; 243: 368-370
        • Benowitz N.L.
        • Brunetta P.G.
        Murray and Nadel’s textbook of respiratory medicine. 5th ed. Saunders Elsevier, Philadelphia, PA2010: 968-984
        • Sorensen L.T.
        Wound health and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy—a systematic review.
        Ann Surg. 2012; 255: 1069-1079
        • Adams C.E.
        • Gabrille J.E.
        • Baillie L.E.
        • Dubbert P.M.
        Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery.
        J Behav Health Serv Res. 2012; 39: 462-471
        • Levine M.D.
        • Kalarchian M.A.
        • Courcoulas A.P.
        • Wisinski M.S.
        • Marcus M.D.
        History of smoking and postcessation weight gain among weight loss surgery candidates.
        Addict Behav. 2007; 32: 2365-2371
        • Aminian A.
        • Andalib A.
        • Ver M.R.
        • Corcelles R.
        • Schauer P.R.
        • Brethauer S.A.
        Outcomes of bariatric surgery in patients with inflammatory bowel disease.
        Obes Surg. 2016; 26: 1186-1190
        • Finks J.F.
        • Kole K.L.
        • Yenumula P.R.
        • et al.
        Predicting risk for serious complications with bariatric surgery: results from the Michigan bariatric surgery collaborative.
        Ann Surg. 2011; 254: 633-640
        • Birkmeyer N.J.
        • Dimick J.B.
        • Share D.
        • et al.
        Hospital complication rates with bariatric surgery in Michigan.
        JAMA. 2010; 304: 435-442
        • Flum D.R.
        • Belle S.H.
        • et al.
        • Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
        Perioperative safety in the longitudinal assessment of bariatric surgery.
        N Engl J Med. 2009; 361: 445-454
        • Freemantle N.
        • Calvert M.
        • Wood J.
        • Eastaugh J.
        • Griffin C.
        Composite outcomes in randomized trials: greater precision but with greater uncertainty?.
        JAMA. 2003; 289: 2554-2559