The Impact of Current Smoking on Wound Complications, A Review of the ACS NSQIP Dataset [11Q

Abstract

INTRODUCTION: Smoking is a modifiable risk factor that is associated with cardiac, respiratory, and wound postoperative complications. We investigate the impact of smoking on postoperative wound complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset was queried for patient who underwent hysterectomy by primary CPT code from 2011 to 2014. CPT codes used included laparoscopic hysterectomy (58570-58573), laparoscopic assisted vaginal hysterectomy (58550-58554), abdominal hysterectomy (58150), vaginal hysterectomy (58260, 58261, 58290, 58291). Smoking was defined by the ACS NSQIP as individuals who have smoked cigarettes within the previous twelve months leading up to surgery. Univariate analysis was used to assess 30 day postoperative wound complications. Wound complications included: superficial surgical site infection (SSI), deep SSI, organ space SSI and wound disruption. RESULTS: There were significant differences between number of wound complications and relative risk for smokers compared to non-smokers undergoing hysterectomy. The relative risk for superficial wound complication is 1.5 (p<0.05), deep surgical site infection is 1.89 (P<0.05), organ space infection is 1.59 (p<0.05), and wound disruption 1.61 (p <0.05) for smokers compared to non-smokers undergoing hysterectomy. The risk of a single complication increases by 1.56 (p<0.001) with smoking, risk of two complications increases by 2.12 (p<0.001), and the risk of having three complications increases by 4.88 (p<0.001). CONCLUSION: Smoking at the time of hysterectomy greatly increased the risk of wound complications. Future studies should investigate the amount of time from smoking cessation to surgery required to decrease the risk of wound complications.