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Just like other would-be ex-smokers, most bariatric surgery patients who quit before the procedure began smoking again in the following years, according to a new study.

Among nearly 1,800 adults who underwent Roux-en-Y gastric bypass, about 85% of those still smoking in the year prior to surgery had quit, Wendy King, PhD, of the University of Pittsburgh Graduate School of Public Health, and colleagues reported in .

Specifically, prevalence of current smoking dropped significantly from 13.7% down to 2.2% during the 12 months prior to surgery.

But rates of current smoking crept back up afterward, with prevalence of 2.2% at time of surgery increasing to 9.6% during the first post-operative year, and reaching 14% by year 7 after surgery -- almost exactly where it stood in the year before undergoing bypass.

"Given the risks associated with smoking, both those related and unrelated to surgery, it's important to note that the prevalence of smoking rebounded to pre-bariatric surgery levels," co- author Gretchen White, PhD, of the University of Pittsburgh School of Medicine, told 番茄社区app. "That it took 7 years to do so highlights the risk of long-term relapse and new-onset smoking."

"Because of that, smoking cessation efforts should focus on long-term maintenance to prevent relapse. Clinicians should be aware of the risk factors for smoking post-surgery."

Smoking rates increased following surgery in all groups defined by smoking history -- including those who reported never smoking prior to bypass:

• No history of smoking: 0% smoker at time of surgery; 1% after 1 year; 3.8% after 7 years
• Former smokers abstinent more than a year: 0% at surgery; 5.2% after 1 year; 12.3% after 7 years
• Smoked during year before surgery: 15.8% at surgery; 55.4% after 1 year; 61.7% after 7 years

"Because cigarette smoking increases the risk of wound and respiratory complications, sepsis, and other adverse events after bariatric surgery, surgeons strongly advise patients to quit smoking prior to surgery," King told 番茄社区app. "However, in general, they pay far less attention to smoking habits after surgery."

She explained that her group was curious to calculate the proportion of patients who successfully stop smoking in preparation for surgery, and subsequently, what percentage pick the habit back up after surgery.

"We also wanted to identify risk factors for smoking after surgery," she added.

The observational analysis included adults with obesity who participated in the multicenter . They underwent initial bariatric surgery from 2006 to 2009.

At the time of surgery, current smokers were more likely to report using smoking as a method of weight control compared with patients who quit within the year prior to surgery (36.8% vs 20.5%).

Not only did smoking prevalence increase among bariatric surgery patients, but the intensity of smoking also increased within the 7 post-operative years. At the time of surgery, smokers reported an average of 0.60 packs/day, increasing to 0.70 and 0.77 packs/day at years 1 and 7 after surgery, respectively.

King said her group was surprised by these findings, noting that both smoking prevalence and intensity in the U.S. decreased during this timeframe. "However, that was not true among study participants who had undergone the Roux-en-Y gastric bypass."

"We hypothesized that weight control might be a motivator, in particular in response to weight regain," she added. But with adjustment for confounding variables, smoking prevalence and intensity didn't differ by motivation for smoking.

Factors that were associated with smoking after bariatric surgery included being younger, having a lower household income -- specifically under $25,000 -- as well as being married, and using illicit drugs.

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