Abstract
BackgroundSmoking is a cause of many postoperative complications, including delayed wound healing, tissue necrosis, and reconstructive flap loss. However, there is a paucity of evidence-based guidelines for smoking cessation in patients undergoing implant-based breast surgery.ObjectiveThe objective of this study was to determine if smoking is associated with wound dehiscence or superficial/deep surgical site infection (SSI) in women undergoing implant-based breast surgery.MethodsUsing theAmerican College of Surgeons National Surgical Quality Improvement Program, data was obtained of U.S. adult females (n=10,077) between the ages of 18 and 70 who underwent insertion of a breast prosthesis from 2014 to 2016. The patient’s preoperative smoking status, demographics, and comorbidities were analyzed to determine association with wound dehiscence, superficial SSI, and deep SSI. Unadjusted and adjusted logistic regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI).ResultsPatients who smoked had a statistically significant higher proportion of wound complications (2.4%) compared to non-smokers (1.3%; p<0.01). Adjusted analysis demonstrated a significantly higher odds of wound complications in smoking patients compared to those who did not smoke (OR 2.0; 95% CI 1.3-3.2).ConclusionsOur study suggests that smoking is an independent risk factor for postoperative complications in patients undergoing implant-based breast surgery. These results have significant clinical implications, as increased precautions can be taken in smokers undergoing breast surgery to minimize postoperative wound complications. Future studies may determine the optimal amount of time that patients should abstain from smoking prior to implant-based breast surgery.
Highlights
Smoking rates in the U.S have dropped substantially from 20.9% in 2005 to approximately 13.7% in 2018, with nearly 12% of all women being current smokers
Adjusted analysis demonstrated a significantly higher odds of wound complications in smoking patients compared to those who did not smoke
Our study suggests that smoking is an independent risk factor for postoperative complications in patients undergoing implant-based breast surgery
Summary
Smoking rates in the U.S have dropped substantially from 20.9% in 2005 to approximately 13.7% in 2018, with nearly 12% of all women being current smokers This is a significant drop, it still translates to an estimated 34.2 million adults in the United States that continue to smoke cigarettes [1]. Previous literature has demonstrated that cigarette smoke delays wound healing in most surgical procedures [4,5], including neurological surgery [6], otologic surgery [7], and various types of plastic and reconstructive surgeries, in which postoperative surgical site complications are already common. Smoking increases the rates of wound complications in nipple reconstruction, autologous breast reconstruction, facelifts, flap-. There is a paucity of evidence-based guidelines for smoking cessation in patients undergoing implant-based breast surgery
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