Evaluating the Impact of Lifting Mandatory Smoking Cessation Prior to Elective Abdominal Wall Reconstruction. A Single-Center Experience

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Introduction Many studies identify active smoking as a significant risk factor for postoperative wound and mesh complications in patients undergoing abdominal wall reconstruction surgery. However, our group conducted an analysis that revealed similar rates of surgical site infection (SSI) and surgical site occurrence requiring procedural intervention (SSOPI) between active smokers and non-smokers (1). As a result, the Cleveland Clinic Center for Abdominal Core Health instituted a policy change where active smokers were no longer subject to surgical delay. In this analysis, we compared the effect of this policy change on clinical outcomes and wound morbidity. Methods We identified active smoking patients who had undergone open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh. Propensity matching was performed to create a 1:3 ratio of "current-smokers" and "never-smokers" and compared wound complications and all 30-day morbidity. Results 106 current-smokers and 304 never-smokers were matched. Rates of SSI (12.2% vs. 6.9%, p = .13), SSO (21.7% vs. 13.2%, p = .052), SSOPI (11.3% vs. 6.3%, p = .13), and reoperation (1.9% vs. 3.9%, p = .53) were not significantly different between active smokers and never-smokers correspondingly. The current-smokers group exhibited a significantly higher incidence of pneumonia compared to the never-smokers group (5.7% vs. 0.7%, p = .005). Conclusion Operating on active smokers did result in a slight increase in wound morbidity, although it did not reach statistical significance. However, we did not see any mesh infections in the smoking group during early follow-up.