The impact of current smoking on outcomes after infrainguinal bypass for claudication.
Citation: Journal of Vascular Surgery. 68(2):495-502.e1, 2018 08.PMID: 29506947Institution: MedStar Heart & Vascular Institute (Baltimore)Form of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Vessel Prosthesis Implantation | *Intermittent Claudication/su [Surgery] | *Peripheral Arterial Disease/su [Surgery] | *Smoking/ae [Adverse Effects] | Aged | Amputation | Blood Vessel Prosthesis Implantation/ae [Adverse Effects] | Blood Vessel Prosthesis Implantation/mo [Mortality] | Chi-Square Distribution | Comorbidity | Databases, Factual | Female | Humans | Intermittent Claudication/di [Diagnosis] | Intermittent Claudication/eh [Ethnology] | Intermittent Claudication/mo [Mortality] | Limb Salvage | Logistic Models | Male | Middle Aged | Peripheral Arterial Disease/di [Diagnosis] | Peripheral Arterial Disease/eh [Ethnology] | Peripheral Arterial Disease/mo [Mortality] | Proportional Hazards Models | Registries | Retrospective Studies | Risk Factors | Smoking Cessation | Smoking/eh [Ethnology] | Smoking/mo [Mortality] | Time Factors | Treatment Outcome | United States/ep [Epidemiology]Year: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:- 0741-5214
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 29506947 | Available | 29506947 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: Current smokers undergoing an infrainguinal bypass procedure for claudication experienced more MALEs than former smokers did. Future studies with longer term follow-up should address limitations of this study by identifying a data source with long-term follow-up examining the relationship of smoking exposure (pack history and duration) with outcomes.
Copyright (c) 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
METHODS: Data from the national Vascular Quality Initiative from 2004 to 2014 were used to identify infrainguinal bypasses performed for claudication. Patients were categorized as former smokers (quit >1 year before intervention) and current smokers (smoking within 1 year of intervention). Demographic and comorbid differences of categorical variables were assessed. Significant predictors were included in adjusted Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) by smoking status for outcomes of major adverse limb event (MALE), amputation-free survival, limb loss, death, and MALE or death. Cumulative incidence curves were created using competing risks modeling.
OBJECTIVE: Although smoking cessation is a benchmark of medical management of intermittent claudication, many patients require further revascularization. Currently, revascularization among smokers is a controversial topic, and practice patterns differ institutionally, regionally, and nationally. Patients who smoke at the time of revascularization are thought to have a poor prognosis, but data on this topic are limited. The purpose of this study was to evaluate the impact of smoking on outcomes after infrainguinal bypass for claudication.
RESULTS: We identified 2913 patients (25% female, 9% black) undergoing incident infrainguinal bypass grafting for claudication. There were 1437 current smokers and 1476 former smokers in our study. Current smoking status was a significant predictor of MALE (HR, 1.27; 95% CI, 1.00-1.60; P = .048) and MALE or death (HR, 1.22; 95% CI, 1.03-1.44; P = .02). Other factors found to be independently associated with poor outcomes in adjusted models included black race, below-knee bypass grafting, use of prosthetic conduit, and dialysis dependence.
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