Smoking Before Revascularization Raises Complication Risks

man smoking a cigarette
man smoking a cigarette
Researchers sought to assess whether smoking before open and endovascular revascularization for intermittent claudication increased risk for postprocedural complications.

For patients with intermittent claudication, smoking prior to undergoing elective revascularization increased risk for postprocedural complications, according to findings from a retrospective cohort study published in JAMA Cardiology.

In the current study, researchers analyzed deidentified data collected between 2011 and 2019 for the Veterans Affairs Surgical Quality Improvement Program. Patients undergoing an elective revascularization due to intermittent claudication were assessed for 30-day outcomes on the basis of smoking status.

Among all eligible patients, 7820 were smokers and 6530 were nonsmokers. The smokers and nonsmokers were 97.7% and 98.8% men; had a mean age of 63.5 and 68.4 years; 75.0% and 78.8% White, and had body mass indexes (BMI) of 26.7 and 29.0, respectively. A propensity-matched subset of 3855 individuals from each group were selected for the final analysis.

Smoking increased risk for any complication (adjusted odds ratio [aOR], 1.36; 95% CI, 1.19-1.55; P <.001). Specifically, risk was increased for minor complications (aOR, 1.51; 95% CI, 1.27-1.81; P <.001), major complications (aOR, 1.21; 95% CI, 1.03-1.13; P =.02), respiratory complications (aOR, 1.85; 95% CI, 1.28-2.69; P =.001), and wound complications (aOR, 1.35; 95% CI, 1.14-1.60; P <.001).

Stratified by subgroups, smoking increased risk for any complication among individuals with chronic obstructive pulmonary disease (OR, 2.08; 95% CI, 1.55-2.79), diabetes (OR, 1.36; 95% CI, 1.10-1.68), infrainguinal disease (OR, 1.26; 95% CI, 1.26-1.79), or suprainguinal disease (OR, 1.06; 95% CI, 1.06-1.80); among patients without frailty (OR, 2.06; 95% CI, 1.61-2.62), cardiovascular disease (OR, 1.59; 95% CI, 1.31-1.90), diabetes (OR, 1.57; 95% CI, 1.28-1.92), or chronic obstructive pulmonary disease (OR, 1.31; 95% CI, 1.11-1.55); and patients who underwent endovascular revascularization (OR, 2.06; 95% CI, 1.28-3.33), open revascularization (OR, 1.60; 95% CI, 1.02-1.60), or hybrid revascularization (OR, 1.27; 95% CI, 1.02-1.59).

Compared with active smokers, patients who had never smoked (aOR, 0.45; 95% CI, 0.34-0.59; P =.01) or were former smokers (aOR, 0.71; 95% CI, 0.61-0.83; P =.005) were both at decreased risk for any revascularization complication at 30 days.

This study may have been limited, as smoking status was self-reported.

“Our findings support the strong societal guidelines emphasizing [optimal medical therapy (OMT)] and call for using comprehensive OMT programs that include smoking cessation therapies prior to revascularization for IC to reduce both early postprocedural complications and long-term CVD morbidity and mortality,” the study authors noted.


Reitz KM, Althouse AD, Meyer J, et al. Association of smoking with postprocedural complications following open and endovascular interventions for intermittent claudication. JAMA Cardiol. Published online October 6, 2021. doi:10.1001/jamacardio.2021.3979