From the Journals

Smoking has small effect on postop hernia wound morbidity



Smoking before elective clean open ventral hernia repair (OVHR) was not associated with significant differences in postoperative wound morbidity or all 30-day morbidity, according to results published in Surgery.

Open hernia surgery castillodominici/Thinkstock

The question of the impact of smoking on infection risk and wound healing has been studied in a variety of surgical procedures. While some associations have been established (JAMA Surg. 2017;152[5]:476-83; Infect Immun. 2015;83[6]:2443-52), the data have not been strong enough to lead to recommendations that surgeons delay procedures until a patient stops smoking.

In a study of 418 active smokers and 418 matched patients who had never smoked, the rate of surgical site infection (SSI) was 4.1% in both groups (P = .98). The total 30-day complication rates were 7.5% for current smokers and 6.6% for nonsmokers (P = .60), reported Clayton C. Petro, MD, of the department of general surgery at the Cleveland Clinic Comprehensive Hernia Center, and his coauthors.

Patient data were obtained from the Americas Hernia Society Quality Collaborative (AHSQC), and included those who had undergone OVHR in a Centers for Disease Control and Prevention class 1 wound with 30-day follow-up.

Participants were grouped according to smoking status: those who had never smoked, those who had smoked within 30 days of operation (“current smokers”), and patients who had quit smoking more than 1 month before operation (“former smokers”). Current smokers were matched with never smokers by characteristics including age, sex, and body mass index, and conditions such as diabetes and hypertension. Former smokers were excluded.

The investigators collected data from both groups on SSI, surgical site occurrence (SSO), surgical site occurrence requiring a procedural intervention (SSOPI), and all 30-day morbidity (any morbidity event entered into the AHSQC database within 30 days of operation), the authors said.

Rates of SSI were 4.1% for both smokers and nonsmokers (P = .98). Rates of SSO were greater in current smokers (12.0% vs. 7.4%, P = .03). SSOPI and reoperation rates were similar in current and never smokers (6.2% vs. 5.0%, P = .43; 1.9% vs. 1.2%, P = .39, respectively).

The results suggest that “active smoking before an elective OVHR in a CDC class I wound has a clinically negligible impact on postoperative wound morbidity and all 30-day morbidity,” wrote Dr. Petro and his colleagues.

“Surgeons allowing perioperative smoking should monitor their outcomes to [ensure that] these findings are replicable in their own practice,” they concluded.

The study authors disclosed financial relationships with Medtronic, Ariste Medical, and other companies.

SOURCE: Petro CC et al. Surgery. 2019 Feb;165(2):406-11.

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