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

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.