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The effect of smoking on surgical outcomes in ventral hernia repair: a propensity score matched analysis of the National Surgical Quality Improvement Program data

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Abstract

Purpose

Although studies have implicated smoking as a positive predictor of post-operative outcomes in inguinal hernia repair, its impact on ventral hernia repair (VHR) is not as clear. This study aims to fill this gap by investigating the impact of smoking on developing adverse 30-day post-operative outcomes in VHR.

Methods

Patients undergoing VHR between 2005 and 2014 were extracted from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by smoking status and compared for significant differences in baseline characteristics. Logistic regression modeled the impact of smoking on the primary outcome variable of 30-day mortality and the secondary outcome variables of 30-day overall, cardiac, respiratory, or wound morbidity. To evaluate the influence of smoking in comparable groups undergoing VHR, a propensity score matched analysis was performed.

Results

Out of 169,458 patients identified, 32,973 (19.5%) were classified as current smokers. Smokers and non/ex-smokers differed significantly in multiple pre-operative baseline characteristics. Unmatched univariate analyses revealed smoking status as a positive predictor of every post-operative outcome. These findings were validated with propensity score matching analyses, which found current smokers have an increased likelihood of 30-day mortality (OR 1.42), overall morbidity (OR 1.39), wound (OR 1.40), respiratory (OR 1.14), or cardiac morbidity (OR 1.88) compared to non/ex-smokers (p < 0.05 for all).

Conclusions

Smoking is a modifiable risk factor with a detrimental impact on outcomes in patients undergoing ventral hernia repair. Delaying VHR and promoting smoking cessation prior to surgery may help reduce the odds of adverse 30-day post-operative outcomes.

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Authors and Affiliations

  1. Department of Surgery, New Jersey Medical School, Rutgers University, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA

    N. P. Borad & A. M. Merchant

Authors
  1. N. P. Borad
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  2. A. M. Merchant
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Corresponding author

Correspondence to A. M. Merchant.

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Conflict of interest

NB declares no conflict of interest. AM declares an Honorarium from Medtronic for Hernia/Mesh Focus group.

Ethical approval

Ethical approval was provided by the Institutional Review Board at Rutgers Biomedical Health Sciences.

Human and animal rights

Our study is a retrospective database analysis and therefore does not involve human or animal research.

Informed consent

Our study is a retrospective database analysis and therefore does not require informed consent.

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Borad, N.P., Merchant, A.M. The effect of smoking on surgical outcomes in ventral hernia repair: a propensity score matched analysis of the National Surgical Quality Improvement Program data. Hernia 21, 855–867 (2017). https://doi.org/10.1007/s10029-017-1664-1

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  • DOI: https://doi.org/10.1007/s10029-017-1664-1

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