Does active smoking really matter before ventral hernia repair? An AHSQC analysis

Area of Science:

• Surgical outcomes research
• Public health and smoking impact

Background:

• Existing research inconsistently links active smoking to postoperative complications and morbidity.
• Previous studies lack standardized criteria, hindering clinical significance assessment.
• This study specifically examines smoking's impact on outcomes after open ventral hernia repair (OVHR).

Purpose of the Study:

• To investigate the clinical significance of active smoking as a risk factor for wound complications and 30-day morbidity after open ventral hernia repair.
• To address inconsistencies in previous research by using a large, quality collaborative database.

Main Methods:

• Analysis of patients undergoing elective open ventral hernia repair from the Americas Hernia Society Quality Collaborative.
• 1:1 propensity matching of current smokers (within 30 days of surgery) to never-smokers based on demographics, comorbidities, and operative factors.
• Assessment of wound complications and all 30-day morbidity in matched cohorts.

Main Results:

• Matched cohorts included 418 current smokers and 418 never-smokers.
• Active smokers had higher rates of overall surgical site occurrences (12.0% vs 7.4%), driven by cellulitis and seroma.
• No significant increases were observed in surgical site infections, complications requiring intervention, reoperations, or overall 30-day morbidity for active smokers.

Conclusions:

• Active smoking before elective open ventral hernia repair is associated with wound complication rates that are not clinically significant.
• Surgeons permitting perioperative smoking should validate these findings within their own patient populations.