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Smoking Cessation After Lower Extremity Revascularization In The Vascular Quality Initiative
Warren J. Carter
1, Andrew W. Schwartz
1, Hannah Zwibelman, MD
2, Edouard Aboian, MD
2, Britt Tonnessen, MD
2, Jonathan Cardella, MD
2, Raul J. Guzman, MD
2, Cassius Iyad Ochoa Chaar
2.
1Yale School of Medicine, New Haven, CT, USA,
2Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
OBJECTIVES: Smoking cessation is crucial for managing peripheral arterial disease (PAD) and remains a high priority in quality improvement for vascular specialists. The SVS launched the CAN-DO campaign in 2023 to promote smoking cessation efforts in the vascular community. This study examines trends in smoking cessation and factors associated with continued smoking after lower extremity revascularization (LER).
METHODS: Patients who were current smokers at the time of index LER in the Vascular Quality Initiative (VQI) Peripheral Vascular Intervention (PVI), Infrainguinal (Infra) and Suprainguinal (Supra) Bypass databases were identified. Patients in the Infra and Supra modules were combined into lower extremity bypass (LEB) and smoking cessation was captured based on long-term follow up. Characteristics and perioperative outcomes between patients who continued smoking and patients who stopped were compared.
RESULTS: This analysis included 138,421 PVI patients and 53,241 LEB patients. From 2010-2023, there was a significant downtrend in the percentage of current smokers undergoing PVI and LEB. Smoking cessation after both PVI and LEB also exhibited significant decrease. (Figure) Current smokers comprised a significantly larger proportion of patients undergoing LEB compared to PVI (44% vs 35%, P<0.001). Current smokers were more likely to achieve cessation after LEB compared to PVI (39% vs 33%, P<0.001). Patients that continued smoking after LER were more likely to be younger, white males with COPD undergoing elective PVI for claudication. Patients who eventually quit smoking after LER were significantly more likely to experience perioperative complications after PVI (3.3% vs. 2.1%, P<0.001) and LEB (11% vs. 9.4%, P<0.001) with specifically higher cardiac complications and major amputations. Regression analysis revealed elective surgery (OR=1.22[1.16-1.28]), endovascular surgery (OR=1.35[1.30-1.41]), claudication (OR=1.17[1.13-1.21]), COPD (OR=1.38[1.32-1.43]), and younger age (OR=0.99[0.98-0.99]) were significantly associated with continued smoking after LER.
CONCLUSIONS: Even though the proportion of smokers undergoing LER is decreasing, achieving smoking cessation has become more challenging. Smoking cessation efforts should particularly focus on younger patients undergoing elective endovascular LER for claudication.
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