P328. The Association Between Smoking and Early Outcomes in Open Thoracoabdominal Aortic Aneurysm Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Baylor College of Medicine/Texas Heart Institute
Iowa Colony, TX
United States - Contact Me
Robert Seniors is a native of Tallahassee Florida, where he attended Florida A&M University and obtained his undergraduate degree in Biology. He then matriculated to Morehouse School of Medicine and conducted research focusing on health disparities and educational outcomes. After which, he matched into General Surgery residency at University of Texas at Houston. After completing two years of clinical training, he pursued a two year research sabbatical at Baylor College of Medicine in the Cardiothoracic Surgery department's T32 fellowship. He is married with a newborn son. Robert has aspirations to match into a cardiothoracic surgery fellowship after completion of general surgery residency and to ultimately become an adult cardiac surgeon.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Smoking is a predominant risk factor associated with the incidence and progression of abdominal aortic aneurysm. However, gaps still exist in understanding the association between smoking history and early operative outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair. We sought to identify potential differences in early operative outcomes between patients with or without a history of smoking undergoing open TAAA repair. We hypothesized that patients currently smoking would be at higher risk of early morbidity after open TAAA repair.
Methods: After excluding patients with unknown smoking status, we performed a retrospective analysis of 2,825 patients who underwent elective open TAAA repair (1986-2023) by a single practice. Patients were stratified into three groups based on self-reported smoking history; 746 (26.4%) reported currently smoking, 1530 (54.2%) were former smokers, and 549 (19.4%) never smoked. Current smoking was defined as having smoked in the last 4 weeks prior to admission, and former smoking referred to the cessation of smoking at least 4 weeks prior to surgery. Adverse event was defined as a composite of operative death or persistent renal failure requiring hemodialysis, stroke, paraplegia, or paraparesis.
Results: Please refer to the table for data and p-values. Patients who were never smokers were significantly younger (median age, 58 years) than current and former smoking patients (both 68 years, p<.001). While current and former smoking patients had similar rates of coronary artery disease and peripheral vascular disease, patients who were never smokers had lower rates. Current smoking patients presented with a markedly higher prevalence of COPD (63%) compared to former smoking (53%) and never smoking (13%, p<.001) patients. Patients who were never smokers were more likely to undergo extent I repair, while former and current smoking patients were more likely to undergo extents III and IV repair; extent II repairs were similar between groups. Although the operative mortality rate was lower in patients who were never smokers (4.9% [n=27]) compared to former and current smoking patients (7.6% [n=117] and 7.4% [n=55] respectively), the difference did not reach statistical significance. The rates of adverse event and specific complications-including persistent paraplegia (0.2% in never smoking patients vs. 2.5% in former and 3.9% in current smoking patients, p<.001), acute renal dysfunction, cardiac complication, and pulmonary complications-was markedly lower in patients who never smoked and similar between patients who were former or current smokers.
Conclusions: A history of smoking is associated with increased peri-operative morbidity after open TAAA repair. Of note, we found never smokers to rarely experience postoperative persistent paraplegia. Contrary to our hypothesis, we were unable to demonstrate a significant difference in outcomes between current and former smoking patients. Further investigation is needed to evaluate whether early outcome benefits may be more pronounced as the duration of smoking cessation increases from the time of surgery. Nevertheless, smoking cessation should be encouraged in all patients currently smoking upon diagnosis of a TAAA.
Authors
Robert Seniors (1), Lynna Nguyen (2), Veronica Glover (1), Susan Green (3), Marc Moon (4), Joseph Coselli (5), Samantha Xu (6), Subhasis Chatterjee (7), Scott A. LeMaire (8)
Institutions
(1) Baylor College of Medicine/Texas Heart Institute, Houston, TX, (2) Baylor College of Medicine, Houston, TX, (3) N/A, Houston, TX, (4) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (5) Baylor College of Medicine, Texas Heart Institute, United States, (6) N/A, United States, (7) Baylor St. Luke's Medical Center, Houston, TX, (8) Geisinger Commonwealth School of Medicine, Scranton, PA
Methods: After excluding patients with unknown smoking status, we performed a retrospective analysis of 2,825 patients who underwent elective open TAAA repair (1986-2023) by a single practice. Patients were stratified into three groups based on self-reported smoking history; 746 (26.4%) reported currently smoking, 1530 (54.2%) were former smokers, and 549 (19.4%) never smoked. Current smoking was defined as having smoked in the last 4 weeks prior to admission, and former smoking referred to the cessation of smoking at least 4 weeks prior to surgery. Adverse event was defined as a composite of operative death or persistent renal failure requiring hemodialysis, stroke, paraplegia, or paraparesis.
Results: Please refer to the table for data and p-values. Patients who were never smokers were significantly younger (median age, 58 years) than current and former smoking patients (both 68 years, p<.001). While current and former smoking patients had similar rates of coronary artery disease and peripheral vascular disease, patients who were never smokers had lower rates. Current smoking patients presented with a markedly higher prevalence of COPD (63%) compared to former smoking (53%) and never smoking (13%, p<.001) patients. Patients who were never smokers were more likely to undergo extent I repair, while former and current smoking patients were more likely to undergo extents III and IV repair; extent II repairs were similar between groups. Although the operative mortality rate was lower in patients who were never smokers (4.9% [n=27]) compared to former and current smoking patients (7.6% [n=117] and 7.4% [n=55] respectively), the difference did not reach statistical significance. The rates of adverse event and specific complications-including persistent paraplegia (0.2% in never smoking patients vs. 2.5% in former and 3.9% in current smoking patients, p<.001), acute renal dysfunction, cardiac complication, and pulmonary complications-was markedly lower in patients who never smoked and similar between patients who were former or current smokers.
Conclusions: A history of smoking is associated with increased peri-operative morbidity after open TAAA repair. Of note, we found never smokers to rarely experience postoperative persistent paraplegia. Contrary to our hypothesis, we were unable to demonstrate a significant difference in outcomes between current and former smoking patients. Further investigation is needed to evaluate whether early outcome benefits may be more pronounced as the duration of smoking cessation increases from the time of surgery. Nevertheless, smoking cessation should be encouraged in all patients currently smoking upon diagnosis of a TAAA.
Authors
Robert Seniors (1), Lynna Nguyen (2), Veronica Glover (1), Susan Green (3), Marc Moon (4), Joseph Coselli (5), Samantha Xu (6), Subhasis Chatterjee (7), Scott A. LeMaire (8)
Institutions
(1) Baylor College of Medicine/Texas Heart Institute, Houston, TX, (2) Baylor College of Medicine, Houston, TX, (3) N/A, Houston, TX, (4) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (5) Baylor College of Medicine, Texas Heart Institute, United States, (6) N/A, United States, (7) Baylor St. Luke's Medical Center, Houston, TX, (8) Geisinger Commonwealth School of Medicine, Scranton, PA
Presentation Duration
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