TY - JOUR
T1 - Does active smoking really matter before ventral hernia repair? An AHSQC analysis
AU - Petro, Clayton C.
AU - Haskins, Ivy N.
AU - Tastaldi, Luciano
AU - Tu, Chao
AU - Krpata, David M.
AU - Rosen, Michael J.
AU - Prabhu, Ajita S.
N1 - Funding Information:
There was no financial support for this study.
Funding Information:
Ajita Prabhu reports personal funding from Medtronic as a consultant and an institutional grant for an ongoing trial from Intuitive. Michael Rosen reports the following: personal funding as a board member and stock options from Ariste Medical; money paid from Intuitive to the institution as PI of an ongoing randomized controlled trial; money paid to the institution for a research grant from Pacira; and salary from AHSQC as chief medical officer.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Background: Many studies implicate active smoking as a risk factor for postoperative wound complications and all 30-day morbidity, but the definitions of inclusion and exclusion criteria as well as outcome parameters are inconsistent. Critically, the ability of large databases and meta-analyses to generate statistically significant associations of active smoking with morbidity do not address whether those relationships are actually clinically meaningful. We investigated this relationship after open ventral hernia repair. Study Design: Patients undergoing elective open ventral hernia repair in clean wounds with 30-day follow-up were extracted from the Americas Hernia Society Quality Collaborative. Current smokers (within 30 days of surgery) were 1:1 propensity matched to patients who had never smoked based on demographics, comorbidities, and operative characteristics. Wound complications and all 30-day morbidity were assessed. Results: After matching 418 current smokers to 418 patients who had never smoked, the groups were similar with the exception of minor differences in body mass index (31.4 vs 33.3, P <.001) and incidence of chronic obstructive pulmonary disease (18% vs 6%, P <.001). Rates of surgical site occurrence were greater in active smokers (12.0% vs 7.4%, P =.03) driven by increased rates of wound cellulitis (2.4% vs 1.2%) and seroma (5.5% vs 1.2%); however, rates of surgical site infection (4.1 vs 4.1, P =.98), surgical site occurrences requiring a procedural intervention (6.2% vs 5.0%, P =.43), reoperation (1.9% vs 1.2%, P =.39), and all 30-day morbidity (7.5 vs 6.6, P =.60) were not significantly increased in active smokers. There were no instances of mesh excision. Conclusion: Active smoking prior to elective clean OVHR is associated with clinically insignificant differences in wound morbidity. Surgeons allowing perioperative smoking should monitor their outcomes to assure these findings are replicable in their own practice.
AB - Background: Many studies implicate active smoking as a risk factor for postoperative wound complications and all 30-day morbidity, but the definitions of inclusion and exclusion criteria as well as outcome parameters are inconsistent. Critically, the ability of large databases and meta-analyses to generate statistically significant associations of active smoking with morbidity do not address whether those relationships are actually clinically meaningful. We investigated this relationship after open ventral hernia repair. Study Design: Patients undergoing elective open ventral hernia repair in clean wounds with 30-day follow-up were extracted from the Americas Hernia Society Quality Collaborative. Current smokers (within 30 days of surgery) were 1:1 propensity matched to patients who had never smoked based on demographics, comorbidities, and operative characteristics. Wound complications and all 30-day morbidity were assessed. Results: After matching 418 current smokers to 418 patients who had never smoked, the groups were similar with the exception of minor differences in body mass index (31.4 vs 33.3, P <.001) and incidence of chronic obstructive pulmonary disease (18% vs 6%, P <.001). Rates of surgical site occurrence were greater in active smokers (12.0% vs 7.4%, P =.03) driven by increased rates of wound cellulitis (2.4% vs 1.2%) and seroma (5.5% vs 1.2%); however, rates of surgical site infection (4.1 vs 4.1, P =.98), surgical site occurrences requiring a procedural intervention (6.2% vs 5.0%, P =.43), reoperation (1.9% vs 1.2%, P =.39), and all 30-day morbidity (7.5 vs 6.6, P =.60) were not significantly increased in active smokers. There were no instances of mesh excision. Conclusion: Active smoking prior to elective clean OVHR is associated with clinically insignificant differences in wound morbidity. Surgeons allowing perioperative smoking should monitor their outcomes to assure these findings are replicable in their own practice.
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U2 - 10.1016/j.surg.2018.07.039
DO - 10.1016/j.surg.2018.07.039
M3 - Article
C2 - 30220485
AN - SCOPUS:85053147080
VL - 165
SP - 406
EP - 411
JO - Surgery (United States)
JF - Surgery (United States)
SN - 0039-6060
IS - 2
ER -