Should all pre-operative bariatric patients stop smoking?
Smoking is a big concern in the general population, but bariatric patients have twice as much risk of becoming smokers. Quitting smoking before a bariatric surgical procedure should benefit these patients. But what is the reality? Data suggests that those who are forced to quit smoking 6 months before surgery will resume smoking within 2 years following the procedure, and that there is no actual difference regarding smoking habits in the pre-operative period and in the postoperative period.
Dr. Aminian talks about the risk of bariatric surgery in smokers, who present a higher risk of marginal ulcer after a Roux-en-Y gastric bypass (RYGB), as well as a higher rate of immediate adverse events, such as pneumonia or sepsis, and mortality both after RYGB and laparoscopic sleeve gastrectomy (LSG).
Bearing in mind that LSG is a safe procedure, Dr. Aminian wonders whether performing this procedure in smokers would be justified. If the ultimate goal of bariatric surgery is to improve survival and quality of life by reducing cardiovascular mortality, smokers would benefit the most since they are at greater risk.
To illustrate this hypothesis, Dr. Aminian presents data from the Cleveland Clinic regarding the results of 37 patients who smoked within one year before and after a LSG and yet their predicted cardiovascular risk decreased. Smokers have more postoperative complications but nevertheless they benefit the most from surgery.
The benefit of smoking cessation in bariatric surgery has yet to be studied properly, and the optimal interval between quitting and surgery is still unknown. LSG seems to be a well tolerated procedure in smoker patients too, and could be considered in selected patients who are unable to quit smoking.