The Effect of Preoperative Smoking Cessation Duration on Outcomes after Elective Open Abdominal Aortic Aneurysm Repair and Lower Extremity Bypass
Nkiruka Arinze1, Alik Farber, MD1, Scott R. Levin1, Thomas W. Cheng1, Douglas W. Jones, MD2, Virendra I. Patel, MD3, Denis Rybin, PhD1, Gheorghe Doros, PhD1, Jeffrey J. Siracuse, MD1
1Boston University, Boston, MA, USA, 2Boston Medical Center, Boston, MA, USA, 3Columbia University Medical Center, New York, NY
Objectives: Smoking has been associated with poor postoperative outcomes across various surgical procedures. However, the effect of preoperative smoking cessation is unclear. Our goal was to assess the temporal effect of smoking cessation before elective open vascular surgery on perioperative outcomes.
Methods: The Vascular Quality Initiative was reviewed for all patients with a documented smoking history and who underwent an elective lower extremity bypass (LEB) or open abdominal aortic aneurysm (AAA) repair from 2010 to 2017. Patients were categorized into three groups: long-term smoking cessation (LTSC, ≥8 weeks prior to surgery), short-term smoking cessation (STSC, < 8 weeks prior to surgery), and current smokers (CS). Multivariable analysis and propensity matching were used to compare outcomes among groups.
Results: We identified 17403 patients with a documented smoking history who underwent elective LEB (43.0% LTSC, 2.2% STSC, 54.8% CS) and 5215 patients who underwent an elective open AAA repair (42.9% LTSC, 2.4% STSC, 54.7% CS). In matched analysis, there was no statistically significant effect of LTSC or STSC outcomes after LEB. However, LTSC patients compared to CS did have increased incidence of postoperative cardiac complications after LEB: new onset congestive heart failure (1.5% vs 1.2%), myocardial infarction (2.3% vs 1.4%) and dysrhythmia (3.4% vs. 2.8%) (P<.001 for all) prior to matching. In matched analysis of outcomes after open AAA repair, LTSC was significantly associated with decreased pulmonary complications (OR .65, 95% CI .53-.79, P<.001), but no significant association was seen with STSC (OR .52, 95% CI .25-1.08, P=.08). LTSC and STSC were not significantly associated with cardiac and or wound complications, leg or bowel ischemia, return to the operating room, or 30-day mortality.
Conclusions: LTSC was associated with significantly decreased odds of pulmonary complications after elective open AAA repair but was not associated with perioperative outcomes after elective LEB. STSC was not associated with perioperative outcomes after LEB or open AAA repair. If time permits, a longer period of smoking cessation should be attempted before elective open AAA.
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