Smoking relapse after bariatric surgery: insights from a statewide registry.

Cohort studySurgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery· Jul 2026

Smoking relapse after bariatric surgery: insights from a statewide registry.

Ryan Howard, Mami K-Sarr Sow, Ahmad Hider … Nabeel R Obeid

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Bariatric & Metabolic SurgeryCohort studyClinical practiceQ1IF 2.1

7.4% of bariatric surgery patients relapsed to smoking within 1 year

Smoking relapse after bariatric surgery: insights from a statewide registry.

Ryan Howard … Nabeel R Obeid

Surgery for obesity and related diseases · Jul 2026 · Q1 in Surgery

Background

Nicotine use after bariatric surgery can lead to serious complications.

Purpose

To determine the incidence of smoking relapse 1 year after bariatric surgery and to identify patient, clinical, and smoking-related risk factors for relapse.

Methods

Using a statewide bariatric-specific data registry, we conducted a retrospective review of 15,421 former smokers who underwent bariatric surgery between 2014 and 2023.

Results

smoking came back for a small share within a year despite quitting before surgery

AOR by subgroup · 95% CI

More results

The cohort had a mean age of 46.5 years and was predominantly female (80.4%).

The strongest predictor of relapse was quitting smoking within 1 year before surgery (adjusted odds ratio [aOR]: 14.55; 95% confidence interval [CI]: 8.28-25.56).

More results

Additional tobacco product use (aOR: 2.17; 95% CI: 1.07-4.39) and greater number of pack-years (aOR: 1.02 per pack-year; 95% CI: 1.01-1.04) were also associated with higher risk of relapse.

More recent surgery was linked to lower odds of relapse (aOR: .75 per year; 95% CI: .64-.88).

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Conclusion · 1 of 2

Despite smoking cessation prior to bariatric surgery, 7.4% of patients resumed smoking at 1 year. Shorter duration of smoking cessation before surgery, multiple tobacco product use, and uninsured status increased risk.

Conclusion · 2 of 2

Identifying at-risk patients may guide targeted postoperative support and improve long-term outcomes.

Smoking relapse after bariatric surgery: insights from a statewide registry.

Smoking relapse after bariatric surgery: insights from a statewide registry.

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