A5077 - Morbidity And Mortality Of Gastric Sleeve And Bypass Patients With Smoking

Background: As the popularity of weight loss surgery options such as the Roux-en-Y gastric bypass and the vertical sleeve gastrectomy increases, the risk-benefit analysis for patient selection becomes more important. Identifying significant pre-operative co-morbidities is important in the patient selection process, especially for patients with coronary artery disease as well as peripheral vascular disease. Smoking plays a key factor in these disease processes, and warrants investigation in the selection process. This study is designed to analyze the risk factor of smoking within the patient population undergoing these procedures and how it affects post-operative success, recovery, and complications. Methods: This is a retrospective cohort study with patients recruited from the Loma Linda University Healthcare Bariatric Surgery database. Data was collected from patients that received either the gastric sleeve or bypass procedure from July 2012 to July 2015. Inclusion criteria are patients above the age of 18 who underwent laparoscopic vertical sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. Patients were excluded if they were younger than 18 years or lost to follow-up within 30 days after surgery. Patients were separated into 3 groups determined by the following smoking status; never (Group A), former (Group B), or current (Group C). Current smokers were defined as patients actively smoking during initial consult. These patients were educated and counseled, and ceased smoking 6 weeks before the procedure. Follow-up was continued on all groups for a minimum of 1 year. The 3 groups were then analyzed for complication rates, and operative success using the Chi-Square method. Complications were graded as either early (within 30 days) or late (after 30 days), as well as major or minor. Major complications were assessed as reoperation, wound infection, leak, venous thrombosis, or death. All other complications were deemed minor. Results: A total of 235 patients were collected, 149 in Group A, 71 in Group B, and 15 in Group C. Group A demonstrated a 24/149 (16.1%) complication rate, Group B had 12/71 (16.9%), and Group C had 1/15 (6.7%). The overall complications from the procedure was 37/235 (15.7%), there were no deaths. 10 of the complications were major complications, including 7 wound infections, 1 DVT, 1 leak, and 1 gastro-gastric fistula. 27 of the complications were minor, including dehydration, nausea, emesis, and diarrhea. 22 of the complications were early, and 15 were late. The chi-square statistic for the study is 1.0182, with a p-value of 0.601027. This shows no significance in the results between the groups. Conclusion: Our study revealed that smoking status demonstrated no significant difference in morbidity or mortality outcomes in bariatric patients. With adequate education and tobacco cessation 6 weeks prior, patients can still successfully undergo bariatric surgery. Limitations of the study included a small sample size, retrospective nature, as well as short duration of follow-up (1 year). Additional factors that could be investigated include how long former smokers have quit smoking, and different levels of smoking stratified by pack years, as well as smoking status on efficacy of weight loss.