Effect of patient-reported smoking status on short-term bariatric surgery outcomes

Preoperative patient screening is a major contributor to the remarkable safety of bariatric surgery. Smoking status is a modifiable patient risk factor, and smoking cessation is associated with improved outcomes in surgical patients. However, the length of smoking cessation necessary to optimize bariatric surgery patient outcomes is not yet defined. We sought to explore the relationship between patient-reported smoking status and short-term bariatric surgery outcomes.

Using prospectively collected data from the MBSC registry, we evaluated the effects of patient-reported length of tobacco abstinence on 30-day surgical outcomes. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) patients (n = 49,772) were divided into three categories based on smoking status: never smoker, former smoker, and recent smoker. We compared risk-adjusted complication rates using multivariable logistic regression models and compared excess body weight loss using a one-way ANOVA test.

The risk-adjusted rate of severe complications among RYGB patients in the recent smoker group was significantly increased relative to patients who had never smoked (OR 1.34; 95% CI, 1.01-1.77), but not among SG patients (OR 1.18; 95% CI 0.87-1.62). In the same populations, differences in overall complication rate were not significant for either RYGB (OR, 1.11; 95% CI 0.94-1.31) or LSG (OR 1.04; 95% CI 0.86-1.25).

Recent smokers suffer detrimental effects of smoking on serious postoperative complications following RYGB surgery, but may not suffer an elevated risk of complications attributable to smoking for sleeve gastrectomy. An evaluation of the effect on long-term outcomes is necessary to further define the risks of smoking on bariatric surgery outcomes.