Physician Practice Habits Treating Claudicants who Smoke

Introduction: Peripheral Arterial Disease (PAD) affects over 200 million people worldwide, with 30%-40% of patients presenting with intermittent claudication. Smoking is the most important modifiable risk factor in treating PAD. Smoking cessation is currently recommended before surgical intervention for intermittent claudication, but interventions are offered and conducted on a physician-specific basis. Our study aimed to identify global trends in surgical intervention for intermittent claudication in active smokers. Methods: A 14-question survey was sent to members of the Society of Vascular Surgery (SVS) to collect information on demographics of the respondent and their intervention strategy in active smokers. A total of 729 interventions lists responded from every geographic region. Survey results were compiled and analyzed to determine trends in surgical intervention by geographic region, specialty, and years in practice. Results: Physicians in North America were less willing to perform open (56.7% vs. 69.9% in Asia, 67.6% in Europe, and 66.7% of other regions, p=0.024) or endovascular surgery (68.4% vs. 77.1% of Asian physicians, 75.0% of European physicians, 74.2% of other regions, p=0.24) on actively smoking claudicants than physicians in other geographic regions. Asian and North American physicians were more likely to insist on one-month of smoking cessation prior to intervention (57.1% in Asia, 56.6% in North America vs. 34.9% in Europe and 40.1% in other regions, p=0.0003). Physicians with more years in practice (over 10 years) had an impact on open surgeries offered to active smokers (57.7% for 20 years, p=0.017), but did not significantly impact the offering of endovascular intervention (77.8% for 10-20 years vs. 69.5% for <10 years and 71.9% for >20 years, p=0.13). Conclusion: Surgical interventions offered to actively-smoking claudicants vary by geographic region and physician years in practice. Physicians in regions of lower tobacco use prevalence are less willing to offer intervention to active smokers. Physicians with more years in training are more willing to offer open intervention to active smokers. Additional studies should be conducted as tobacco use trends change and to further evaluate the variations in provider specialty.