A seven-year University of Pittsburgh study has found that patients undergoing gastric bypass surgery resume smoking soon after the critical procedure despite being aware of the risks involved.
Cigarette smoking is a major concern in bariatric (or weight-loss) surgery because it can slow the healing process and increase risks of ulcer formation, bleeding, and stomach obstruction. Nicotine and other chemicals found in tobacco constrict the blood vessels and reduce blood flow to the stomach. These also increase carbon monoxide (CO) levels in the blood which in turn compromises the ability of red blood cells to carry oxygen. A non-smoker has CO between 0-8 parts per millions (ppm) in his body; if you consume one pack of cigarettes a day, the CO level jumps to about 20 ppm; with two packs a day, it reaches 40 ppm. CO can be lethal. To reduce the risk of potential complications, patients are usually advised to quit smoking prior to undergoing bariatric surgery.
Lead author of the study Wendy King, who is also an associate professor of epidemiology at Pitt Public Health believes the healthcare experts must realize the risk that smoking poses to such patients and improve effective communication with the patient during the follow-ups,
“Smoking cessation prior to surgery is strongly recommended to reduce surgical complications. But there isn’t the same emphasis on maintaining cessation after surgery. Our findings show that there is a need for ongoing support in order to reduce and quickly respond to relapses.”
King and the team followed 1770 patients who underwent gastric bypass surgery. Gastric bypass and other weight-loss surgeries, collectively known as bariatric surgery, are one of the most sought-after procedures for weight loss in obese and morbidly obese patients. More than 113,000 people undergo a knife each year to cut the excess fat and reduce stomach size. A single procedure (balloons, sleeve, revision, band, etc) costs between $15,000-25000.
The study participants were surveyed for their smoking habits for 7 years; more than 45% had been regular smokers with 14% quitting a year before the surgery. The number came down to 2% a month before the surgery but soared to 10% within a year of surgery and gradually relapsed to 14% in the 7-year follow up.
What was startling was the fact that some of the patients (2 out of 5) who had never smoked in life started smoking after surgery.
“Interestingly, the people who picked up smoking post-surgery weren’t just the people who quit smoking in the year prior to surgery, presumably to prepare for the operation. Many had never smoked, to begin with,” said Gretchen White, Ph.D., assistant professor in Pitt’s School of Medicine and co-author of the study.
Furthermore, the smokers upped their smoking game post-surgery; those who smoked 12 cigarettes a day before surgery started smoking 15 cigarettes a day.
The researchers also noticed that the pattern is not similar in all weight-loss procedures because compared to the gastric bypass group, patients who underwent gastric banding were not as susceptible to nicotine cravings. In gastric (or lap) banding, a silicon belt is tied around the stomach to reduce its size as well as the capacity to hold food. A smaller stomach gives a feeling of satiety quickly. Lap-band is a relatively less popular procedure, in 2018 only 1.1% of total of 252,000 patients opted for it.
The researchers also identified the causes of smoking relapse in gastric bypass patients. These included a history of smoking, poverty, younger age and being married.