Variation in smoking cessation after vascular operations
Name:
Publisher version
UMass Chan Affiliations
Department of SurgeryDocument Type
Journal ArticlePublication Date
2013-05-01Keywords
AgedAngioplasty
Aortic Aneurysm, Abdominal
Blood Vessel Prosthesis Implantation
Carotid Artery Diseases
Chi-Square Distribution
Endarterectomy, Carotid
Female
Humans
MaleMiddle AgedMultivariate AnalysisNew EnglandOdds RatioPeripheral Vascular Diseases*Physician's Practice PatternsPostoperative CarePrevalenceRegistriesRisk Factors*Risk Reduction BehaviorSmoking*Smoking CessationStentsTime FactorsTreatment OutcomeVascular Diseases*Vascular Surgical ProceduresSurgery
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OBJECTIVE: Smoking is the most important modifiable risk factor for patients with vascular disease. The purpose of this study was to examine smoking cessation rates after vascular procedures and delineate factors predictive of postoperative smoking cessation. METHODS: The Vascular Study Group of New England registry was used to analyze smoking status preoperatively and at 1 year after carotid endarterectomy, carotid artery stenting, lower extremity bypass, and open and endovascular abdominal aortic aneurysm repair between 2003 and 2009. Of 10,734 surviving patients after one of these procedures, 1755 (16%) were lost to follow-up and 1172 (11%) lacked documentation of their smoking status at follow-up. The remaining 7807 patients (73%) were available for analysis. Patient factors independently associated with smoking cessation were determined using multivariate analysis. The relative contribution of patient and procedure factors including treatment center were measured by chi-pie analysis. Variation between treatment centers was further evaluated by calculating expected rates of cessation and by analysis of means. Vascular Study Group of New England surgeons were surveyed regarding their smoking cessation techniques (85% response rate). RESULTS: At the time of their procedure, 2606 of 7807 patients (33%) were self-reported current smokers. Of these, 1177 (45%) quit within the first year of surgery, with significant variation by procedure type (open abdominal aortic aneurysm repair, 50%; endovascular repair, 49%; lower extremity bypass, 46%; carotid endarterectomy, 43%; carotid artery stenting, 27%). In addition to higher smoking cessation rates with more invasive procedures, age >70 years (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.30-2.76; P < .001) and dialysis dependence (OR, 2.38; 95% CI, 1.04-5.43; P = .04) were independently associated with smoking cessation, whereas hypertension (OR, 1.23; 95% CI, 1.00-1.51; P = .051) demonstrated a trend toward significance. Treatment center was the greatest contributor to smoking cessation, and there was broad variation in smoking cessation rates, from 28% to 62%, between treatment centers. Cessation rates were higher than expected in three centers and significantly lower than expected in two centers. Among survey respondents, 78% offered pharmacologic therapy or referral to a smoking cessation specialist, or both. The smoking cessation rate for patients of these surgeons was 48% compared with 33% in those who did not offer medications or referral (P < .001). CONCLUSIONS: Patients frequently quit smoking after vascular surgery, and multiple patient-related and procedure-related factors contribute to cessation. However, we note significant influence of treatment center on cessation as well as broad variation in cessation rates between treatment centers. This variation indicates an opportunity for vascular surgeons to impact smoking cessation at the time of surgery. rights reserved.Source
Hoel AW, Nolan BW, Goodney PP, Zhao Y, Schanzer A, Stanley AC, Eldrup-Jorgensen J, Cronenwett JL; Vascular Study Group of New England. Variation in smoking cessation after vascular operations. J Vasc Surg. 2013 May;57(5):1338-44; quiz 1344.e1-4. doi:10.1016/j.jvs.2012.10.130. Link to article on publisher's site
DOI
10.1016/j.jvs.2012.10.130Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49710PubMed ID
23375433Related Resources
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