Increased Associated Risk of Surgical Site Infections in Trauma Patients Who Are Smokers

Smoking has been shown to increase the risk of surgical site infection (SSI) in elective surgery. This study aimed to determine the association between smoking and SSI in trauma patients (TPs), hypothesizing that TPs who are smokers have an increased associated risk of SSI compared to nonsmokers.

The Trauma Quality Improvement Program database (2017-2022) was queried for adults (age ≥ 18 y) undergoing any surgery related to trauma. Patients with length of stay < 48 h were excluded. The primary outcome was SSI. In addition to bivariate analyses, multivariable logistic regression analyses were performed to assess the associated risk of SSI in smokers versus nonsmokers, as well as planned subgroup analyses in patients with severe trauma (injury severity score (ISS) ≥16 and ≥ 25).

Of 1,043,112 TPs, 254,017 (24.3%) were smokers. Compared to nonsmokers, smokers were younger (42 versus 53 y old, P < 0.001) and had higher rates of SSIs (0.9% versus 0.7%, P < 0.001). This was consistent in patients with ISS ≥16 (1.7% versus 1.4%, P < 0.001) and ISS ≥25 (2.0% versus 1.6%, P < 0.001). An increased associated risk for smokers persisted in multivariable analyses after controlling for age and steroid use in all patients (Odds ratio (OR) 1.15, 1.09-1.20 P < 0.001), as well as TPs with ISS ≥16 (OR 1.19, 1.12-1.26, P < 0.001) and ISS ≥25 (OR 1.19, 1.10-1.29, P < 0.001).

Nearly a quarter of TPs were smokers, and these patients had an increased rate and associated risk of SSI. Interestingly, smoking was more strongly associated with SSI in patients suffering severe trauma. Given the urgent nature of trauma operations, patients should be counseled appropriately regarding their increased associated risk of SSI, and more research is required to determine if any preventative public health measures or perioperative interventions can mitigate the increased risk of SSI in this high-risk population.