We sought to prove a significant relationship between cigarette smoking and wound healing problems in reduction mammaplasty patients, to show the effect of stopping smoking before the procedure, and to justify the implementation of urine nicotine testing preoperatively. One hundred and seventy-three consecutive patients aged 16 to 67 years underwent bilateral reduction mammaplasty in our institution over 26 months. Patients were advised to stop smoking at least 4 weeks prior to surgery. Records were reviewed and smoking habits reconfirmed via telephone. Wound problems were registered when intervention was necessary. Smokers made up 38.5% of the cases. Wound healing problems showed statistical significance (P < 0.05) between smokers (55.4%) and nonsmokers (33.7%). More than 75% of smokers admitted denying smoking within 4 weeks of surgery. Trend analysis revealed a significant association of wound healing problems for those who stopped longer than 4 weeks (33.3%), those who stopped less than 4 weeks (52.6%), and those who persisted until the operation (67.7%). Smoking increased wound healing problems after bilateral reduction mammaplasty. The introduction of compulsory urine nicotine testing at the preadmission clinic and prior to the operation will provide objective verification of patients' smoking history, minimize morbidity, and enable healthcare cost savings.
BACKGROUND: Preoperative smoking cessation has been suggested to be effective in reducing various postoperative complications. However, the optimal duration of preoperative smoking cessation for reducing wound complications is unclear.
METHODS: One hundred eighty-eight consecutive patients who underwent reconstructive head and neck surgery at the authors' institution were included in this retrospective study. Information on preoperative smoking habits was obtained from the patients' medical records. Smokers were defined as having smoked within 7 days before surgery. Late, intermediate, and early quitters were defined as patients whose duration of abstinence from smoking was 8-21, 22-42, and 43 days or longer before the operation, respectively. Patients who required postoperative debridement, resuture, or reconstruction of their flap before hospital discharge were defined as having had impaired wound healing.
RESULTS: The incidences (95% confidence intervals) of impaired wound healing among the late, intermediate, and early quitters and nonsmokers were 67.6% (52-83%), 55.0% (33-77%), 59.1% (47-71%), and 47.5% (32-63%), respectively, and the incidence of impaired wound healing was significantly lower among the intermediate quitters, early quitters, and nonsmokers than among the smokers (85.7% [73-97%]). After controlling for sex, age, American Society of Anesthesiologists physical status, operation time, history of diabetes mellitus, chemotherapy, radiation therapy, and the type of flap, the odds ratios (95% confidence intervals) for development of impaired wound healing in the late, intermediate, early quitters, and nonsmokers were 0.31 (0.08-1.24), 0.17 (0.04-0.75), 0.17 (0.05-0.60), and 0.11 (0.03-0.51), respectively, compared with the smokers.
CONCLUSIONS: Preoperative smoking abstinence of longer than 3 weeks reduces the incidence of impaired wound healing among patients who have undergone reconstructive head and neck surgery.
OBJECTIVE: The purpose of this study was to determine if a perisurgical smoking cessation program reduces smoking-related postoperative complications in urogynecologic surgery.
STUDY DESIGN: A review of patients that underwent pelvic reconstructive surgery from 1998 to 2003 was performed. All smokers underwent a perisurgical smoking cessation program of their choice for at least 1 month before surgery, and continued for 1 month after surgery. Complications unrelated to smoking (cystotomy, enterotomy, urethral obstruction, etc) were excluded in the smoking-potentiated complications. Problems considered to be potentiated by smoking were: wound, pulmonary, cardiac, and febrile morbidity.
RESULTS: Eight hundred eighty-seven patients were included. There were 233 smoker cessation patients (SC) and 654 nonsmokers (NS). The total number of complications in the SC group was 61 (61/233, 26%) compared with 172 (172/654, 29%) in the NS group: (chi-square, P = .97). When looking at smoking-potentiated complications only, there were 34 (34/61, 56%) patients in the SC group and 90 (90/172, 52%) in the NS group (chi-square, P = .75).
CONCLUSION: There are no differences in smoking-potentiated complications between nonsmoking patients and patients who undergo a perisurgical smoking cessation program.
OBJECTIVE: Clinical studies show that the incidence of postoperative wound complications is higher in smokers than nonsmokers. In this study, we evaluated the effect of abstinence from smoking on incisional wound infection.
METHODS: Seventy-eight healthy subjects (48 smokers and 30 never-smokers) were included in the study and followed for 15 weeks. In the first week of the study, the smokers smoked 20 cigarettes per day. Subsequently, they were randomized to continuous smoking, abstinence with transdermal nicotine patch (25 mg per day), or abstinence with placebo patch. At the end of the first week and 4, 8, and 12 weeks after randomization, incisional wounds were made lateral to the sacrum to excise punch biopsy wounds. At the same time identical wounds were made in 6 never-smokers. In 24 never-smokers a wound was made once. All wounds were followed for 2 weeks for development of wound complications.
RESULTS: A total of 228 wounds were evaluated. In smokers the wound infection rate was 12% (11 of 93 wounds) compared with 2% (1 of 48 wounds) in never-smokers (P <0.05). Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4, 8, and 12 weeks after randomization. No difference between transdermal nicotine patch and placebo was found.
CONCLUSIONS: Smokers have a higher wound infection rate than never-smokers and 4 weeks of abstinence from smoking reduces the incidence of wound infections.
