Preoperative smoking is associated with early graft failure after infrainguinal bypass surgery.

Abstract

OBJECTIVE:

Smoking has been implicated as the single most important risk factor for the development of peripheral arterial disease. Whereas previous studies have found poor long-term outcomes in smokers undergoing lower extremity bypass, there is a lack of consistent reports describing the effects of persistent tobacco abuse on early outcomes after infrainguinal bypass.

METHODS:

The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2011 was queried for primary infrainguinal bypasses. A bivariate analysis was done to assess preoperative and intraoperative risk factors for the primary outcome of 30-day graft failure comparing active smokers with nonsmokers, defined as patients who did not smoke within the 12 months before surgery. Multivariable logistic regression was conducted to assess the independent association of active smoking with graft failure.

RESULTS:

In 6614 (40.0%) active smokers and 9920 (60.0%) nonsmokers, 16,534 infrainguinal bypasses were performed. Active smokers were more likely to be younger, male, and of nonwhite race and to have a history of chronic obstructive pulmonary disease (P < .001, all). Nonsmokers were more likely to be functionally dependent and had significantly more comorbidities (ie, hypertension, diabetes, obesity, congestive heart failure, history of previous cardiac surgery or intervention, and dialysis; P < .001, all). The presence of critical limb ischemia was similar in both groups (53.1% of active smokers vs 53.5% of nonsmokers; P = .61). More nonsmokers received a tibial-level bypass than did active smokers (47.8% vs 33.9%; P < .001). There was a trend toward increased early graft failure in active smokers compared with nonsmokers (5.3% vs 4.7%; P = .08). With adjustment for other variables, especially bypass level and graft type, there was an independent association between active smoking and early graft failure (adjusted odds ratio, 1.21; 95% confidence interval, 1.02-1.43; P = .03).

CONCLUSIONS:

Although nonsmokers were significantly older, had more comorbidities, and required more distal revascularization, active smokers still had an increased risk for development of early graft failure. These results stress the need for immediate smoking cessation before lower extremity bypass. Further research is warranted to determine an optimal period of abstinence among smokers with peripheral arterial disease to reduce their risk for early graft failure.

• Authors: Shalini Selvarajah, James H Black 3rd, Mahmoud B Malas, Ying Wei Lum, Brandon W Propper, Christopher J Abularrage
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 59 Issue 5 Pg. 1308-14 (May 2014) ISSN: 1097-6809 [Electronic] United States
• PMID: 24502815 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Blood Vessel Prosthesis Implantation (adverse effects)
• Chi-Square Distribution
• Comorbidity
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Peripheral Arterial Disease (diagnosis, surgery)
• Risk Factors
• Sex Factors
• Smoking (adverse effects)
• Smoking Cessation
• Smoking Prevention
• Time Factors
• Treatment Failure