Editor's Choice – Prevalence of Smoking and Impact on Peri-Operative Outcomes After Elective Abdominal Aortic Aneurysm Repair

Abstract

Contemporary UK data on the burden of smoking in patients undergoing elective abdominal aortic aneurysm (AAA) repair are lacking.This nationwide cohort study of the National Vascular Registry found a high prevalence of smoking in this cohort (21.9%), with a 2.4 fold variation in smoking rates across hospitals in the United Kingdom.Active smoking was associated with higher overall complication rates compared with non-smokers and former smokers, specifically respiratory and ischaemic complications, and admission to intensive care.Smoking cessation programmes are a priority for patients undergoing AAA repair to reduce rates of smoking and improve peri-operative outcomes.Objective: The contemporary burden of smoking in patients undergoing elective abdominal aortic aneurysm (AAA) repair in the UK is unknown.This study aimed to quantify the prevalence of smoking in patients undergoing AAA repair in the UK and determine the association between smoking and peri-operative outcomes.Methods: This was an observational cohort study.The National Vascular Registry was interrogated for adults undergoing elective infrarenal AAA repair from 2014 to 2021 for prevalence of current smokers, former smokers, and non-smokers over time.The primary outcomes were post-operative complications by smoking status.Secondary outcomes were variation in smoking rates over time and by hospital, in hospital mortality, and length of stay by smoking status.All analyses were adjusted using the validated British Aneurysm Repair score.Results: Overall, 26 916 patients undergoing elective AAA repair were included (21.9% smokers, 62.2% former smokers, 15.9% non-smokers).The prevalence of smoking did not change over time, with a 2.4 fold variation between UK hospitals (range 13.0 e 31.8% excluding outliers).In hospital mortality was not significantly different between smokers, former smokers, and non-smokers (p > .050for all comparisons).Compared with non-smokers, smoking was associated with increased overall (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.24 e 1.57) and respiratory complications (OR 1.98, 95% CI 1.63 e 2.39), limb ischaemia (OR 1.63, 95% CI 1.19 e 2.23), bowel ischaemia (OR 1.64, 95% CI 1.06 e 2.54), return to theatre (OR 1.38, 95% CI 1.11 e 1.71), and intensive care admission (OR 1.43, 95% CI 1.31 e 1.56).Compared with former smokers, smoking was associated with increased overall (OR 1.24, 95% CI 1.14 e 1.36), respiratory (OR 1.44, 95% CI 1.27 e 1.63) and limb ischaemia complications (OR 1.48, 95% CI 1.19 e 1.84), and intensive care admission (OR 1.37, 95% CI 1.28 e 1.46).On analysis of the endovascular aneurysm repair subgroup, active smoking was associated with significantly higher rates of limb ischaemia compared with former and non-smokers (OR 2.12, 95% CI 1.49 e 3.01 and OR 1.94, 95% CI 1.19 e 3.16 respectively). Conclusion:The prevalence of smoking remains high in patients undergoing elective AAA repair with no evidence of a decline in active smokers from 2014 to 2021 compared with the general UK population.Smoking is associated with increased peri-operative complication rates.

Topics & Concepts