S. Ross1, C. R. Huntington1, T. Cox1, L. Blair1, B. Oommen1, A. Walters1, A. Lincourt1, R. Sing1, B. T. Heniford1, V. Augenstein1 1Carolinas Medical Center,Charlotte, NC, USA
Introduction:
Several studies have shown that smoking increases rates of complications following surgery. This study quantifies the effect of smoking on ventral hernia repair (VHR) using national outcomes data.
Methods:
The NSQIP database was queried from 2005-2011 for all elective laparoscopic VHR (LVHR) and open VHR (OVHR). Patients were stratified by surgical approach, and outcomes were compared by current smoking status using standard statistical tests. Multivariate regression (MVR) was performed for outcomes controlling for age, sex, BMI, diabetes, Charlson Comorbidity Index (CCI), recurrent and incarcerated hernia.
Results:
There were 75,332 VHRs identified: 9,153 LVHR and 66,179 OVHR. In their respective strata, LVHR and OVHR were similar (means or percentage): smokers (19.5% vs 21.4%), age (56.8±13.4 vs 56.4±14.2), male (40.4% vs 42.6%), BMI (33.6±8.1 vs 32.5±8.4), CCI (0.4±0.8 vs 0.5±1.1), diabetic (16.6% vs 16.7%), tobacco use in pack years (10.3±21.0 vs 11.0±21.4), recurrent hernia (23.6% vs 22.8%), and incarcerated hernia (28.2% vs 22.1%). In LVHR, smokers were similar to nonsmokers by rates of recurrent hernia, gender, and mean CCI (p>0.05); however, they had decreased age, BMI, and diabetes rates and increased rate of incarceration (p<0.05). In OVHR, smokers had equivalent CCI (p>0.05) but were more often male with increased rates of recurrent and incarcerated hernias. For non smokers, OVHR had decreased mean age, BMI, and CCI(p<0.05). Results of MVR are displayed in the Table and show a higher odds ratio for all complications examined for smokers undergoing OVHR, including reoperation, readmission and mortality (p<0.05). Additionally, major complications and readmission odds were increased in the smokers undergoing LVHR (p<0.05). Paradoxically, length of stay was actually shorter in the smoker group for both repair types (p<0.05).
Conclusion:
Smoking has a substantial negative impact on operative morbidity in LVHR, but has a markedly significant effect on patient outcomes in OVHR. Smoking can be a prognostic indicator of wound and major complications, reoperations, readmission, and mortality. If a repair must be performed, a LVHR is less morbid than an OVHR in a current smoker. Based on these data, smoking may be an absolute contraindication in elective OVHR.
