A considerable group of bariatric surgery patients continue smoking after surgery despite advice to quit and temporary quitting before surgery, according to researchers from The Netherlands. The authors noted that this is the first study in bariatric surgery evaluating self-reported smoking behaviour combined with thoughts about the health consequences of smoking cessation and actual health outcomes in current, former and never smokers. They noted that the patients who do continue to smoke were less aware of the beneficial effects of smoking cessation and demonstrates the need for better strategies to increase the number of successful cessations.
The paper, ‘Smoking Behaviour and Beliefs About Smoking Cessation After Bariatric Surgery’, published in Obesity Surgery, sought to evaluate the smoking behaviour and thoughts about smoking cessation of patients more than 18 months after primary or revisional bariatric surgery, and reported the actual bariatric surgery outcomes in the subgroups defined by smoking status.
After enrolment, patients were asked to complete a written questionnaire consisting of 51 questions on general information, current and past smoking, alcohol and addictive drugs use. Questions were asked on some of the following issues: current smoking behaviour; any history of smoking; total time of smoking during lifetime, during preoperative period and postoperative period (pack-years); time of preoperative smoking cessation; type and amount of tobacco (cigarette, rolling tobacco, pipe, cigar); amount and duration of longest quit attempt; number and type of used methods at attempt; thoughts about smoking cessation; consequences on health, weight and success of bariatric surgery; reasons to quit; the experienced support by others for cessation; and chance of continuation of cessation in stressful times.
The study included 609 patients (85.7% of the patients were female) with a mean age of 45.9 years and a median body mass index (BMI) of 42.5. Medical history revealed 39.7% of patients had hypertension, 19.5% had T2DM and 53.9% of patients had a previous abdominal surgery, including 11.0% (n=67) of patients who had previous bariatric surgery.
Post-surgery, 101 (16.6%) patients were current smokers, 239 (39.2%) were former smokers (226 (94.6%) of them were already former smoker before surgery) and 269 (44.2%) patients had never smoked.
Former smokers were more aware of the beneficial effects of smoking cessation on general health and, interestingly, the result of bariatric surgery after smoking cessation was thought to be ‘much better’ by 67% of former smokers versus 17% of current smokers.
Mean %TWL in current smokers was 33.6 and 3.4% compared with former smokers and 2.1% higher compared with those who had never smoked (overall p<0.001). Adjustments for sex, pre-operative BMI, HbA1c before surgery and time after surgery, %TWL in current smokers was 2.8% higher compared with former smokers and 2.1% higher compared with those who had never smoked (overall p=0.011).
Remission of T2DM and hypertension, reported hypoglycaemia, readmissions because of abdominal complaints, reoperations related to bariatric surgery, symptomatic gallstones and reported physical or mental hindrance of excess skin were not statistically different between the groups.
“In conclusion, three years after bariatric surgery, 16.6% of the patients was smoking and 44.2% had never smoked in their entire life. The present study emphasizes the need for larger cohort studies with long-term follow-up, investigating better pre- and postoperative strategies to convince smokers to quit and prevent former smokers to relapse. Future research should focus on these strategies, possibly by addressing concerns about weight gain and other reasons interfering with quitting.”
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