Low educational status, smoking, and multidisciplinary team experience predict hospital length of stay after bariatric surgery

Impact of smoking on weight loss outcomes after bariatric surgery: a literature review

BACKGROUND

The association between smoking and surgical complications after bariatric surgery has been well-established. However, given that this patient population is inherently weight-concerned, understanding the effects of tobacco use on postoperative weight loss is essential to guiding clinicians in counseling patients. We aimed to summarize the current literature examining the effects of preoperative and postoperative smoking, as well as changes in smoking status, on bariatric surgery weight loss outcomes.

METHODS

Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies.

RESULTS

Overall, 20 studies were included. Preoperative and postoperative smoking rates varied widely across studies, as did requirements for smoking cessation prior to bariatric surgery. Reported preoperative smoking prevalence ranged from 1 to 62%, and postoperative smoking prevalence ranged from 6 to 43%. The majority of studies which examined preoperative and/or postoperative smoking habits found no association between smoking habits and postoperative weight loss outcomes. A minority of studies found relatively small differences in postoperative weight loss between smokers and nonsmokers; these often became nonsignificant with longer follow-up. No studies found significant associations between changes in smoking status and weight loss outcomes.

CONCLUSION

While smoking has been associated with weight loss in the general population, most current evidence demonstrates that smoking habits are not associated with weight loss outcomes after bariatric surgery. However, due to the heterogeneity in study design and analysis, no definitive conclusions can be made, and more robust studies are needed to investigate any relationship between smoking and long-term weight loss outcomes. Given the established increased risk of surgical complications and mortality in smokers, smoking cessation should be encouraged.

Smoking in bariatric surgery: a systematic review

BACKGROUND

The prevalence of smoking among patients undergoing bariatric surgery has been reported to be as high as 40%. The effect of smoking in the perioperative period has been extensively studied for various surgical procedures, but limited data are available for bariatric surgery. The objective of this study is to review the existing literature to assess: (1) the impact of smoking on postoperative morbidity and mortality after bariatric surgery, (2) the relationship between smoking and weight loss after bariatric surgery, and (3) the efficacy of smoking cessation in the perioperative period among bariatric surgery patients.

METHODS

A comprehensive search of electronic databases including MEDLINE, EMBASE and the Cochrane Library from 1946 to February 2020 was performed to identify relevant articles. Following an initial screen of 940 titles and abstracts, 540 full articles were reviewed.

RESULTS

Forty-eight studies met criteria for analysis: five structured interviews, three longitudinal studies, thirty-two retrospective studies and eight prospective studies. Smoking within 1 year prior to bariatric surgery was found to be an independent risk factor for increased 30-day mortality and major postoperative complications, particularly wound and pulmonary complications. Smoking was significantly associated with long-term complications including marginal ulceration and bone fracture. Smoking has little to no effect on weight loss following bariatric surgery, with studies reporting at most a 3% increased percentage excess weight loss. Rates of smoking recidivism are high with studies reporting that up to 17% of patients continue to smoke postoperatively.

CONCLUSIONS

Although current best practice guidelines recommend only a minimum of 6 weeks of abstinence from smoking prior to bariatric surgery, the findings of this review suggest that smoking within 1 year prior to bariatric surgery is associated with significant postoperative morbidity. More investigation is needed on strategies to improve smoking cessation compliance among bariatric surgery patients in the perioperative period.