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Published on: September 22, 2020
Association of Smoking With Postprocedural Complications Following Open and Endovascular Interventions for
Katherine M Reitz1,2,3, Andrew D Althouse4, Joseph Meyer5
1Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Preprocedural smoking significantly increases the risk of complications following peripheral artery disease revascularization. Smoking cessation before procedures is crucial for optimizing patient outcomes and reducing adverse events.
Area of Science:
- Vascular Surgery
- Public Health
- Cardiovascular Disease
Background:
- Peripheral artery disease (PAD) significantly impacts quality of life, with intermittent claudication (IC) being a common manifestation.
- Smoking is a primary modifiable risk factor for PAD development and progression.
- Smoking cessation is recommended for IC management, yet adherence before revascularization is low.
Purpose of the Study:
- To determine the association between preprocedural smoking and early postprocedural complications after elective lower extremity revascularization.
- To evaluate complication risks across different revascularization modalities (endovascular, hybrid, open) in smokers versus nonsmokers.
Main Methods:
- Retrospective cohort study utilizing the Veterans Affairs Surgical Quality Improvement Program (2011-2019).
- Nearest-neighbor (1:1) propensity score matching included patients with IC, excluding emergent cases and those with chronic limb-threatening ischemia.
- Analysis focused on 30-day complications and mortality, comparing preprocedural smokers with nonsmokers.
Main Results:
- Over half (54.5%) of patients undergoing revascularization were smokers.
- Smokers experienced significantly higher rates of overall complications (12.6% vs. 8.9%) and specific complications (respiratory, wound) across all revascularization types.
- Sensitivity analysis showed significantly lower complication risks for never-smokers (65% reduction) and former smokers (29% reduction) compared to active smokers.
Conclusions:
- Preprocedural smoking is associated with substantially increased early postprocedural complications following elective lower extremity revascularization.
- Higher risks of respiratory and wound complications, as well as graft failure, were observed in smokers.
- These findings underscore the critical importance of smoking cessation programs to improve revascularization outcomes in patients with PAD.
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