The Association between Smoking and Plastic Surgery Outcomes in 40,465 Patients: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets

Plast Reconstr Surg. 2017 Feb;139(2):503-511. doi: 10.1097/PRS.0000000000002958.


Background: Smoking is known to negatively impact postoperative wound healing and increase infection risk. However, few studies have investigated whether the negative effects of smoking are similar for different procedures. The authors examined the association between smoking and postoperative outcomes for a diverse range of plastic surgery procedures.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program data set, demographics and outcomes were examined for patients who underwent plastic surgery between 2007 and 2012. Multivariable logistic regression models assessed the relationship between smoking status and a range of postoperative outcomes, including medical and surgical complications and impaired wound healing. Patients were also evaluated for length of inpatient hospitalization while controlling for multiple demographic factors and type of procedure.

Results: Forty thousand four hundred sixty-five patients were identified from the data set, including patients who had undergone breast, upper and lower extremity, abdominal, and craniofacial procedures. Current smokers constituted 15.7 percent of the cohort. Smokers had a higher likelihood of surgical (OR, 1.37; p < 0.0001) and medical complications (OR, 1.24; p = 0.0323) and increased odds for wound complications (OR, 1.49; p < 0.0001) and wound dehiscence (OR, 1.84; p < 0.0001). Smokers were also found to have increased odds of these complications even when subgroup analysis was performed according to major Current Procedural Terminology categories. Smoking also increased the odds of superficial wound infections (OR, 1.40; p < 0.0001). No difference was observed in hospital length of stay between smokers and nonsmokers.

Conclusions: Smoking increases a multitude of postoperative complications after plastic surgery procedures. The effects of smoking on plastic surgery outcomes should be used to guide patients in preoperative smoking cessation and to evaluate protocols for managing patients who smoke.

Clinical question/level of evidence: Risk, II.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Datasets as Topic
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plastic Surgery Procedures*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology*
  • Quality Improvement
  • Smoking / adverse effects*
  • Treatment Outcome
  • United States
  • Young Adult