Smoking Before Revascularization tied with increased complication risks: JAMA

Smoking is a key modifiable risk factor in the development and progression of peripheral artery disease, which often manifests as intermittent claudication (IC). Smoking cessation is a first-line therapy for IC, yet a minority of patients quit smoking prior to elective revascularization.

A group of researchers conducted a study to assess if preprocedural smoking is associated with an increased risk of early postprocedural complications following elective open and endovascular revascularization.

This retrospective cohort study used nearest-neighbor (1:1) propensity score matching of 2011 to 2019 data from the Veterans Affairs Surgical Quality Improvement Program, including all cases with a primary diagnosis of IC and excluding emergent cases, primary procedures that were not lower extremity revascularization, and patients with chronic limb-threatening ischemia within 30 days of the intervention. All data were abstracted June 18, 2020, and analyzed from July 26, 2020, to June 30, 2021.

The results of the study are as follows:

• Of 14 350 included cases of revascularization, 14 090 patients (98.2%) were male, and the mean (SD) age was 65.7 (7.0) years.
• A total of 7820 patients (54.5%) were smoking within the preprocedural year. There were a total of 4417 endovascular revascularizations (30.8%), 4319 hybrid revascularizations (30.1%), and 5614 open revascularizations (39.1%).
• A total of 1594 patients (11.1%) had complications, and 57 (0.4%) died.
• Among 7710 propensity score–matched cases (including 3855 smokers and 3855 nonsmokers), 484 smokers (12.6%) and 34 nonsmokers (8.9%) experienced complications, an absolute risk difference (ARD) of 3.68%
• Compared with nonsmokers, any complication was higher for smokers following endovascular revascularization, hybrid revascularization, and open revascularization
• Compared with nonsmokers, respiratory complications were higher for smokers following endovascular revascularization, hybrid revascularization, and open revascularization.
• Wound complications and graft failure were higher for smokers compared with nonsmokers following open interventions
• In a sensitivity analysis, compared with active smokers, the risk of any complication was decreased by 65% for never smokers and 29% for former smokers

Thus, the researcher concluded that in this cohort study, more than half of patients with IC were smoking prior to elective revascularization, and complication risks were higher across all modalities of revascularization. These findings stress the importance of smoking cessation to optimize revascularization outcomes.

Reference

Reitz KM, Althouse AD, Meyer J, et al. Association of smoking with postprocedural complications following open and endovascular interventions for intermittent claudication. JAMA Cardiol. Published online October 6, 2021. doi:10.1001/jamacardio.2021.3979