Refraining From Smoking Before Open AAA Repair May Reduce Mortality Risk

Patients who are current smokers who are scheduled to receive open abdominal aortic aneurysm repair should be instructed to refrain from smoking 30 days beforehand.

Refraining from smoking in the 30 days prior to open abdominal aortic aneurysm (AAA) repair decreases perioperative morbidity and mortality rates. These findings were published in the Annals of Vascular Surgery.

Patients (N=55,287) receiving open or endovascular AAA repair between 2003 and 2020 at Loyola University in the Unites States were included in this study. Outcomes at 90 days were evaluated among patients receiving either open AAA repair or endovascular AAA repair.

Among patients receiving open AAA repair, 3788 were currently smoking, 4614 formerly smoked, and 817 had never smoked. Among patients receiving endovascular AAA repair, 14,173 were currently smoking, 25,831 formerly smoked, and 6064 had never smoked. Current smoking was defined as smoking within last 30 days and former smoking was defined as no smoking in the last 90 days.

Patient groups differed on the basis of gender (range, 71.6%-83.8% men) and age (mean range, 67.25-77.43 years).

Smoking cessation 30 days before open AAA repair reduces cumulative perioperative morbidity and mortality.

Mortality at 90 days occurred among the following:

  • 5.5% of open repair active smokers
  • 4.9% of open repair former smokers
  • 4.5% of open repair never smokers
  • 2.5% of endovascular repair never smokers
  • 2.0% of endovascular repair former smokers
  • 1.9% of endovascular repair active smokers

Compared with the endovascular repair active smoking group, never smokers were at increased risk for 90-day mortality (odds ratio [OR], 1.32; P =.008).

Among the open repair group, compared with active smokers, risk for pneumonia was reduced among former (OR, 0.58; P <.001) and never (OR, 0.34; P <.001) smokers, mean blood loss was reduced among former and never smokers (both P <.001), and cumulative morbidity and mortality risk was reduced among never smokers (OR, 0.80; P =.002).

Among the endovascular repair group, compared with active smokers, risk for acute renal insufficiency was increased among former (OR, 1.24; P =.040) and never (OR, 1.46; P =.011) smokers, risk for reintubation was decreased among former smokers (OR, 0.79; P =.028), risk for reoperation was decreased among former smokers (OR, 0.79; P =.002), and mean blood loss was increased among former smokers (P <.001).

Among all patients, 90-day mortality was associated with the following:

  • Anemia (adjusted OR [aOR], 1.987; P <.001)
  • Open AAA repair (aOR, 1.995; P <.001)
  • Congestive heart failure (aOR, 1.754; P <.001)
  • Chronic renal insufficiency (aOR, 1.547; P <.001)
  • Current smoking (aOR, 1.224; P <.001)
  • Coronary artery disease (aOR, 1.144; P =.049)
  • Diabetes (aOR, 1.140; P =.045)
  • Higher maximum AAA diameter (aOR, 1.007; P <.001)
  • Increased age (aOR, 1.044; P <.001)

This study may have been biased by relying on self-reported smoking status.

“Smoking cessation 30 days before open AAA repair reduces cumulative perioperative morbidity and mortality,” the study authors wrote.


Peterson L, Schweitzer G, Simone A, et al. The effect of smoking status on perioperative morbidity and mortality after open and endovascular abdominal aortic aneurysm repair. Ann Vasc Surg. Published online August 31, 2022. doi:10.1016/j.avsg.2022.07.027