(IP103) A Single Institution Review on the Predictors and Effects of Smoking Cessation in Vascular Surgery Patients

Objectives: Smoking is a leading cause of cardiovascular disease (CVD) and smoking cessation (SC) reduces the risk of CVD death, all-cause mortality, and myocardial infarctions (MI), even in patients with arterial disease.1,2 However, among vascular surgery patients, who often include heavy, life-long smokers, there is minimal data on the effects and outcomes of SC. This study aimed to evaluate how SC intervention rates influence SC and long-term health outcomes.

Methods: We conducted a single-institution analysis using data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), a prospective, regional collaborative focused on improving quality of care and outcomes. The cohort included active smokers undergoing vascular surgery from 2018-2023, excluding patients without follow up or identified as never or former smokers. BMC2 provided data on patient age, sex, race, comorbidities, disposition, procedure type, and major adverse cardiovascular events (MACE), including death, strokes and MI. Retrospective chart review recorded hospitalizations following an index vascular procedure and major adverse limbs events (MALE), defined as below or above knee amputation. SC interventions in the preoperative, perioperative, and postoperative periods were aggregated, including physician advice and counseling, nicotine replacement therapy (NRT), pharmacologic medications (Wellbutrin/Chantix), and SC referral or refusal of these interventions.

Results: The study included 518 patients, 352 (68%) did not achieve SC while 166 (32%) did. SC rates were not significantly associated with age (65.6 vs 64.7, p=0.3) and comorbidities. However, there was a 10% increase in the percentage of females that achieved SC compared to a 10% decrease in males (p=0.02). Similarly, African Americans had a 3.5% increase in the proportion of patients who achieved SC vs a 5% decline in Caucasians (p=0.03). Multivariable regression, controlling for age, gender, comorbidities, disposition, and procedure type showed no effect of SC on MACE or MALE (p=0.33), but the number of hospitalizations did significantly affect the probability of SC (Figure1). A Kaplan-Meier survival plot demonstrated no effect of preoperative intervention on time to SC. A Cox proportional hazards survival curve showed that patients with more hospitalizations had higher rates of any SC but experienced longer overall time to sustained SC (Figure 2).

Conclusions: Females and African Americans quit at significantly higher rates. SC did not impact MACE or MALE and preoperative interventions had no effect on time to SC. The number of hospitalizations significantly influenced any SC. However, more hospitalizations led to higher recurrence rates, resulting in longer times to sustained SC.