Should recent smoking be a contraindication for sleeve gastrectomy?

Area of Science:

• Bariatric and metabolic surgery
• Cardiovascular health
• Surgical outcomes

Background:

• Bariatric surgery aims to reduce cardiovascular risks in obese patients.
• Smokers have higher cardiovascular event risks and may gain significant benefits from bariatric surgery.
• The safety of sleeve gastrectomy in smokers requires further characterization.

Purpose of the Study:

• To evaluate the independent impact of smoking on early postoperative complications and mortality following laparoscopic sleeve gastrectomy.

Main Methods:

• Utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
• Analyzed data from 33,714 patients undergoing primary laparoscopic sleeve gastrectomy (2010-2014).
• Compared 30-day postoperative outcomes between smokers (smoked within one year pre-surgery) and nonsmokers.

Main Results:

• Smokers had a higher likelihood of unplanned reintubation (OR=1.88).
• Smokers experienced increased composite morbidity (4.3% vs. 3.7%), serious morbidity (0.9% vs. 0.6%), and 30-day mortality (0.2% vs. 0.1%).
• These risks persisted even after excluding patients with COPD, indicating a direct effect of smoking.

Conclusions:

• Laparoscopic sleeve gastrectomy is well-tolerated in both smokers and nonsmokers.
• Patients smoking within a year pre-surgery face a slightly elevated, though still low, risk of 30-day morbidity and mortality.
• Long-term benefits of improved comorbidities need to be weighed against this modest perioperative risk increase.