Smoking increases the risk of postoperative wound complications: A propensity score‐matched cohort study

Abstract

Cigarette smoking is associated with surgical complications, including wound healing and surgical site infection. However, the association between smoking status and postoperative wound complications is not completely understood.Our objective was to investigate the effect of smoking on postoperative wound complications for major surgeries. Data were collected from the 2013 to 2018 participant use files of the American College of Surgeons National Surgical Quality Improvement Program database. A propensity score matching procedure was used to create the balanced smoker and nonsmoker groups. Multivariable logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative wound complications, pulmonary complications, and in-hospital mortality associated with smokers. A total of 1 156 002 patients (578 001 smokers and 578 001 nonsmokers) were included in the propensity score matching analysis. Smoking was associated with a significantly increased risk of postoperative wound disruption (OR 1.65, 95% CI 1.56-1.75), surgical site infection (OR 1.31, 95% CI 1.28-1.34), reintubation (OR 1.47, 95% CI 1.40-1.54), and in-hospital mortality (OR 1.13, 95% CI 1.07-1.19) compared with nonsmoking. The length of hospital stay was significantly increased in smokers compared with nonsmokers. Our analysis indicates that smoking is associated with an increased risk of surgical site infection, wound disruption, and postoperative pulmonary complications. The results may drive the clinicians to encourage patients to quit smoking before surgery.

A Prospective Study on the Outcome After Mass Closure of Post-laparotomy Wound Dehiscence in a Tertiary Care Hospital, Tamil Nadu, India

“…There was an increase in a variety of complications such as infection, wound rupture, anastomotic leakage, wound and flap necrosis, and epidermolysis and a decrease in the tensile strength of wounds of those who had a history of smoking [16][17][18]. Inoue et al found that smoking cessation for four weeks before surgery can reduce the duration of hospital stay and the rate of suture failure [19].…”

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma

“…Nicotine is a potent vasoconstrictor which significantly reduces blood flow to wound beds, which increases the local risk of infection, delayed healing, wound dehiscence and tissue necrosis. [22][23][24][25][26][27] This article is protected by copyright. All rights reserved.…”

“…Nicotine is a potent vasoconstrictor which significantly reduces blood flow to wound beds, which increases the local risk of infection, delayed healing, wound dehiscence, and tissue necrosis. [22][23][24][25][26][27] Carbon monoxide and hydrogen cyanide, two toxic gases absorbed by the body following exposure to cigarette smoke, have also been implicated. 28 Previous studies have shown that the successful healing of a skull base repair and prevention of postoperative CSF leak is multifactorial.…”

Cohort study to characterise surgical site infections after open surgery in the UK’s National Health Service

“…Three risks factors (smoking, body mass index and CCI score) have consistently been shown in the published literature to be important risk factors for SSI development 22–28. Any one of these three were used to signify a high-risk patient in this study.…”

“…Patients were considered to be at high-risk of developing an SSI if they were smokers,22 23 or had a body mass index >35 kg/m24 25 or a Charlson Comorbidity Index (CCI) score26–28 equal to or greater than 3 2. All other patients were considered to be low-risk.…”