Variation in Smoking Cessation After Vascular Operations

Abstract

Smoking is the most important modifiable risk factor for patients with vascular disease. Vascular operations represent a potential opportunity for surgeons to influence smoking cessation. The purpose of this study was to examine smoking cessation rates after vascular procedures and delineate factors predictive of postoperative smoking cessation. The Vascular Study Group of New England (VSGNE) registry was used to analyze smoking status preoperatively and at 1-year follow-up. Of 10,734 patients who underwent operations between 2003 and 2009, follow-up smoking data were available for 7807 (73%). Subsequent procedures on a single patient were excluded. Factors independently associated with smoking cessation were determined using multivariate analysis. Variation between centers was evaluated by calculating expected rates of cessation from the multivariate model and by analysis of means. VSGNE surgeons were surveyed regarding their smoking cessation techniques (an 85% response). At the time of their procedure 2,606 of 7,807 patients (33%) were self-reported current smokers. Of these, 1,177 (45%) quit within the first year of surgery, with significant variation by procedure type (CAS, 27%; carotid endarterectomy, 43%; infrainguinal bypass, 46%; endovascular aneurysm repair, 49%; open abdominal aortic aneurysm [AAA] repair, 50%). Age >70 years (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.30-2.76, P < .001), dialysis dependence (OR, 2.38; 95% CI, 1.04-5.43; P = .04), and open AAA repair (OR, 1.30; 95% CI, 1.03-1.63, P = .027) were independently associated with smoking cessation. Chronic obstructive pulmonary disease (OR, 0.76; 95% CI, 0.65-0.9, P = .001) and CAS (OR, 0.5; 95% CI, 0.27-0.92, P = .025) were associated with continued smoking. Independent of these factors, there was significant variation in smoking cessation rates based on surgeon (from 17 to 85%) and center (from 28 to 62%, Fig). Among survey respondents, 85% offered pharmacologic therapy and/or referral to a smoking cessation specialist. Patients of these surgeons had higher smoking cessation rates than those who did not offer medications or referral (48% vs 33%, P < .001). Patients frequently quit smoking after vascular surgery, particularly after open AAA repair, but cessation rates vary widely between centers and surgeons. This variation indicates an opportunity for vascular surgeons to impact smoking cessation at the time of surgery.