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

Abstract

IntroductionActive 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). MethodsProspectively 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. ResultsEvaluation included 1088 patients, 305 AS and 783 NS. AS had a lower BMI (31.3 vs 32.7 ​kg/m2; 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 ​cm2; 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. ConclusionDespite greater patient and hernia complexity, smoking cessation appears to result in similar outcomes to never-smokers in this AWR population.