The benefits of preoperative smoking cessation on abdominal wall reconstruction outcomes: An examination of abstinent versus never smokers.

Autor: Lorenz WR; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Holland AM; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Kerr SW; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Mead BS; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Scarola GT; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Kercher KW; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Augenstein VA; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Heniford BT; Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Todd.Heniford@gmail.com.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2024 Dec; Vol. 238, pp. 115843. Date of Electronic Publication: 2024 Jul 14.
DOI: 10.1016/j.amjsurg.2024.115843
Abstrakt: Introduction: Active smoking is related to wound and respiratory complications following abdominal wall reconstruction (AWR), but no AWR studies directly compare outcomes of abstinent-smokers (AS), fulfilling four-weeks of smoking cessation, to non-smokers (NS).
Methods: Prospectively maintained institutional database was queried for all AWR between 2012 and 2019. AS and NS were included. Primary outcomes were wound and respiratory complications; secondary outcome was recurrence. Standard statistical analyses were performed.
Results: Evaluation included 1088 patients, 305 AS and 783 NS. AS had a lower BMI (31.3 vs 32.7 ​kg/m 2 ; P ​= ​0.004) but increased ASA Class III (51.5% vs 34.5 ​%, P ​= ​0.009), COPD (8.9% vs 4.0 ​%, P ​= ​0.001), comorbidities (6.3 vs 4.7, P < 0.001), and wound class (Class III/IV: 25.3% vs 15.8 ​%, P ​= ​0.003). AS had increased defect size (229 vs 209.1 ​cm 2 ; P ​= ​0.023), use of component separation (CST) (52.5% vs 43.8 ​%; P ​= ​0.010) and hospital stay (6.6 vs 6.2 days, P ​= ​0.015). Postoperative wound, mesh, and pulmonary infection, respiratory failure, and recurrence were similar. On multivariable regression, wound class and complications predicted recurrence. BMI, panniculectomy and CST predicted wound complications. BMI, CST, and wound class predicted respiratory complications.
Conclusion: Despite greater patient and hernia complexity, smoking cessation appears to result in similar outcomes to never-smokers in this AWR population.
Competing Interests: Declaration of competing interest Dr. Kercher received speaking honoraria from WL Gore. Dr. Augenstein received speaking honoraria from Allergan, Pacira and Bard, and is a consultant for Medtronic and Vicarious Surgical. Dr. Heniford received a surgical education grant and honoraria from WL Gore. Drs. Lorenz, Holland, Kerr, Mead, and Mr. Scarola have no disclosures. We did not receive outside funding for this work. Generative AI software was not used in the evaluation of data or drafting of the manuscript.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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