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Is Smoking Cessation Counseling Prior to CD Surgery on Your Preoperative Checklist?
*Adriana Olariu1, *Caitlin W. Hicks2, *Lillias Holmes Maguire1, Richard A. Hodin1, Liliana Bordeianou1
1Massachusetts General Hospital, Boston, MA;2Johns Hopkins Hospital, Baltimore, MD
Objective: Smoking cessation is recommended as preventive treatment in Crohn’s disease (CD), but recent studies suggest that biologics may attenuate the impact of smoking on disease course. We wanted to determine whether smoking impacts surgical complexity in the era of anti-TNFs.
Design: Retrospective cohort study.
Setting: A tertiary referral hospital.
Patients: 130 consecutive patients with ileal CD undergoing ileocecectomy (2008-2013) were classified into smokers and non-smokers at the time of surgery. Disease characteristics, medical therapy, surgical interventions and outcomes were collected.
Interventions: None.
Main Outcome Measures: Impact of smoking on surgical complexity per Michellasi definition, postoperative complications, and surgical recurrences.
Results: 18% of patients were smokers vs. 17.4% of race-matched adults in MA. Smokers and non-smokers had similar disease duration, indications for surgery, rates of exposure to immunosuppressants and anti-TNFs. However, more smokers were undergoing a reoperation (48% vs 26%, p=0.04). Smokers required complex surgical procedures more often than non-smokers (73.9% vs 54.2%, p=0.007). The mean number of surgical procedures was 2.39±1.17 in smokers, vs 1.88±1.09 in non-smokers (p=0.05). Although fistula closure and strictureplasty rates were similar (p>0.6, both), smokers required other procedures more frequently (60.9% vs 37.3%, p=0.0001). Ultimately, the two groups had similar surgical outcomes, but smokers trended towards higher rates of postoperative complications (34.8% vs 26.2, p=0.4) and had more readmissions (21.7% vs 10.3%, p=0.003).
Conclusions: CD patients treated with ileocolonic resections had a similar prevalence of smoking with the general population. Preoperative smoking was associated with more complex surgical interventions and an increased risk of readmissions and surgical recurrence. While further studies are necessary to validate these findings, surgeons should recommend preoperative smoking cessation in all CD patients.
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