• John O DeLancey, Eddie Blay, D Brock Hewitt, Kathryn Engelhardt, Karl Y Bilimoria, Jane L Holl, David D Odell, Anthony D Yang, and Jonah J Stulberg.
• Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL, USA; Department of Urology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
• Am. J. Surg. 2018 Sep 1; 216 (3): 471-474.

BackgroundAdverse 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.MethodsWe 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.ResultsOf 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.ConclusionsCurrent 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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