COMPLICATIONS

ascular surgery plays an essential role in assisting other surgical services with iatrogenic vascular complications—“something that must be considered when assessing the value proposition of a vascular surgery service line”—the first author of the winning entry in the VAM 2023 Poster Competition told attendees. “Oftentimes, vascular surgery is called for urgent or emergent assistance for patients who are critically ill at non-peak hours when there are less resources available,” Abhishek Rao (pictured center), MD, a vascular surgery integrated resident at Columbia University Medical Center in New York University, said.

He was outlining the main takeaways from his first-place paper, “The significant burden of iatrogenic vascular injury on the vascular surgery workforce at an academic medical center,” for which he took home a $1,500 award.

Rao and colleagues identified all vascular surgery consultations for iatrogenic vascular complications at a single tertiary care center—retrospectively during a seven- secondhand smoke increases the risk of death and disability to those who do not smoke themselves.

CAN-DO includes three components to increase smoking quit rates, including smoking cessation variables (preop smoking in elective procedures only, and smoking cessation for elective, urgent and emergent cases) in the VQI’s arterial registries; physician and patient toolkits; and revising the smoking cessation section on the SVS website in order to make it more patient-centered and increase its visibility.

The VQI currently captures some variables, but the new initiative expands upon them to include smoking status, history and demographics prior to surgery, and in post-op care and long-term follow-up.

Simplicity is stressed. “We’re trying to minimize the burden” on VQI members in terms of the additional variables, Wymer said.

The physician toolkit includes many elements physicians and surgeons will find useful, including results and efficacy from a clinical trial of a brief smoking cessation intervention, a “visual dictionary” on electronic cigarettes and vaping products, an educational library of useful resource documents, the patient-facing document housed on the SVS site and, importantly in a billable world, billable smoking cessation codes.

“We can receive reimbursement for talking to patients about quitting smoking,” said Lemmon. He discussed key phrases and elements to be included to meet the threshold for reimbursement.

The patient toolkit, meanwhile, includes links to many resources on quitting smoking. Patient education is another important component, said Wymer. In the U.S., 30.8 million adults smoke cigarettes, 3.08 million middle and high school students use tobacco products, one in four people who don’t smoke are exposed to secondhand smoke, and more than $240 billion a year goes to treat smoking-related diseases.

Moreover, tobacco companies target specific populations, including people of lower income, and spend $9.1 billion in marketing annually in the U.S.

“There are nearly five times more tobacco retailers per square mile in neighborhoods with the lowest income compared to neighborhoods with the highest income,” she said.

Lemmon also noted that simply asking a patient, “Do you smoke?” is insufficient. Surgeons and doctors should instead extend the conversation to the “3 As”: ask if the patient wants to quit and when the patient smokes that first cigarette of the day; assist by offering liberal use of nicotine replacement therapy and medications, but also add that the patient should not combine e-cigarettes as a crutch while also smoking; and give advice by referring patients to professional counseling, apps and other tools.

Other useful information includes a quick guide to treatment options, including nicotine patches, lozenges, nasal spray, gum and inhalers, and the use of counseling via text messaging, smartphone apps and web-based services.

Wymer and Lemmon also stressed the deleterious effects of smoking on health: increased risk for peripheral artery disease and plaque-building in arteries. Smoking narrows, and thus damages, blood vessel walls; it increases blood pressure and heart rate; affects cholesterol; and increases triglyceride levels, a type of fat found in the blood.

Both the SVS and the American Heart Association advise patients to quit smoking before they undergo surgery.

Learn more at www.vqi.org/smoking-cessation.