C. Lee1, R. Rutledge1, J. Nahmias1, M. Dolich1, M. Lekawa1, C. Barrios1, A. Grigorian1 1University Of California – Irvine, Surgery, Orange, CA, USA
Introduction:
Smoking has been shown to increase the risk of surgical site infection (SSI) and delay wound healing in elective surgery. This is thought to be related to impaired immune cell function and tissue ischemia. In this study, we aim to determine the association between smoking and SSI in trauma patients. We hypothesize that trauma patients who are smokers have an increased associated risk of SSI compared to non-smokers.
Methods:
We queried the TQIP database (2017-2022) for adults (age > 18-years) undergoing any surgery/procedure related to trauma. Patients with length of stay (LOS) < 48 hours were excluded. The primary outcome was SSI. In addition to bivariate analyses, multivariable logistic regression analyses were performed to assess the risk of SSI in all smokers vs non-smokers as well as planned subgroup analyses in patients with severe trauma (ISS >16 and >25).
Results:
Of 1,043,112 trauma patients, 254,017 (24.3%) were smokers. Compared to non-smokers, smokers were younger (42 vs 53 years old, p < 0.001). Smokers had higher rates of SSIs (0.9% vs 0.7%, p<0.001), compared to non-smokers. This was consistent in patients with ISS>16 (1.7% vs. 1.4%, p<0.001) and ISS>25 (2.0% vs. 1.6%, p<0.001). The increased associated risk for smokers persisted in multivariable analyses after controlling for age and steroid use in all patients (1.15 OR, 1.095-1.208, p < 0.001), those with ISS>16 (OR 1.19, 1.12-1.26, p<0.001) and those with ISS>25 (OR 1.19, 1.10-1.29, p<0.001).
Conclusion:
Nearly a quarter of trauma patients were smokers and these patients had increased rates of SSI. Smoking was an independently associated risk factor for SSI and was more strongly associated in patients suffering severe trauma. Given the urgent nature of operations for trauma, patients should be counseled appropriately regarding their risk of SSI and efforts should be made to mitigate this risk with future basic science and translational research.