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Multicenter Study
. 2018 Sep;216(3):471-474.
doi: 10.1016/j.amjsurg.2018.03.004. Epub 2018 Mar 6.

The Effect of Smoking on 30-day Outcomes in Elective Hernia Repair

Free PMC article
Multicenter Study

The Effect of Smoking on 30-day Outcomes in Elective Hernia Repair

John O DeLancey et al. Am J Surg. .
Free PMC article


Background: Adverse postoperative outcomes related to smoking are well established, yet current smokers continue to be offered elective surgery in the US. It is unknown whether patients undergoing low-risk, elective procedures, who actively smoke experience increased risk of complications. We sought to determine the increased burden of complications following elective hernia repair procedures in patients identified as current smokers.

Methods: We identified patients undergoing elective incisional, inguinal, umbilical, or ventral hernia repair from 2011 to 2014 using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. Multivariable logistic regression analysis was used to examine the association between current smoking and 30-day postoperative outcomes, adjusting for demographics and comorbidities.

Results: Of 220,629 patients who underwent elective hernia repair, 40,446 (18.3%) self-identified as current smokers within the past 12 months. Current smokers experienced an increased likelihood (Odds Ratio [95% Confidence interval]) of reoperation (OR 1.23 [95% CI 1.11-1.36]), readmission (OR 1.24 [95% CI 1.16-1.32]), and death (OR 1.53 [95% CI 1.06-2.22]). Furthermore, smokers experienced an increased risk of postoperative pulmonary, infectious, and wound complications, but there was no increased risk of requiring transfusion or of postoperative cardiac or thromboembolic events.

Conclusions: Current smokers were more likely to experience serious postoperative complications within 30 days. Given the volume of elective hernia surgery performed in the US, encouraging smoking cessation prior to offering elective repair could reduce postoperative complications, reoperation, readmission, and mortality.

Conflict of interest statement


KB, DO, AY, and JS declare conflicts of interest not directly related to the submitted work (National Institutes of Health, Agency for Healthcare Research and Quality, American Board of Surgery, American College of Surgeons, Accreditation Council for Graduate Medical Education, Health Care Services Corporation and Blue Cross Blue Shield of Illinois, Mallinkrodt, and Northwestern University). JD, DH, EB, KE, and JH have nothing to disclose.

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