title: Open revascularization procedures are more likely to influence smoking reduction than percutaneous procedures.
abstract: BACKGROUND
  Among patients with peripheral arterial disease (PAD), smokers have a higher incidence of life- and limb-threatening complications, including lower extremity ischemic rest pain, myocardial infarction, and cardiac death, highlighting the need for smoking reduction. Several studies have previously investigated the perioperative period as a teachable moment for smoking cessation. The purpose of this study is to determine whether the type of revascularization for PAD (percutaneous versus open) is associated with smoking reduction.
  
  
  METHODS
  Study participants included patients seen at a tertiary academic medical center in Providence, RI, between 2005 and 2010 and assigned International Classification of Diseases, Ninth Revision code diagnoses indicative of PAD. This study uses patient-answered surveys and retrospective chart review to assess changes in smoking habits after medical, percutaneous, or open revascularization. Surveys also assessed patient perceptions regarding the influence of intervention on smoking reduction and how strongly patients associate PAD with their smoking habits.
  
  
  RESULTS
  Of 54 patients who were active smokers at the time of intervention, 8 (67%) in the medical management group, 12 (50%) in the percutaneous group, and 15 (83%) in the open intervention group reduced smoking by 50% after intervention. After controlling for several confounders, open revascularization was independently associated with smoking reduction when compared with percutaneous intervention (odds ratio, 8.26; 95% confidence interval, 1.18, 76.7; P = 0.043). Surveys revealed that 94% of the patients believed that smoking was a significant contributor to their PAD.
  
  
  CONCLUSIONS
  Patients with PAD who undergo open revascularization are more likely to reduce smoking than those who undergo percutaneous revascularization. The perioperative period provides an opportunity to improve rates of smoking reduction.
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Vascular Surgery, Yale New Haven Hospital, New Haven, Connecticut. Electronic address: sarehsan@gmail.com.
authors.forename: Sareh
authors.initials: S
authors.lastname: Rajaee
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Leonid
authors.initials: L
authors.lastname: Cherkassky
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Marcaccio
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Vascular Surgery, Berkshire Medical Center, Pittsfield, Massachusetts.
authors.forename: Wilfred I
authors.initials: WI
authors.lastname: Carney
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Tze Tec
authors.initials: TT
authors.lastname: Chong
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Manuel
authors.initials: M
authors.lastname: Garcia-Toca
authors.affiliation: Department of Vascular Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Slaiby
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010353:Patient Education as Topic; D010465:Perception; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012237:Rhode Island; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects