The effect of tobacco use on outcomes of laparoscopic and open ventral hernia repairs: A review of the NSQIP dataset

John C Kubasiak, MD, Mackenzie Landin, MD, Scott Schimpke, MD, Jennifer Poirier, PhD, Jonathan A Myers, MD, Benjamin R Veenstra, MD, Keith W Millikan, MD, Minh B Luu, MD. Rush University Medical Center

Introduction: Tobacco smoking is a known risk factor for complications after major surgical procedures. The full effect of tobacco use on these complications has not been studied over large populations for ventral hernia repairs.  This effect is more important as the pre-operative conditioning and optimization of patients is adopted. We sought to use the prospectively collected ACS-NSQIP dataset to evaluate respiratory and infectious complications for patients undergoing both laparoscopic and open ventral hernia repairs.

Methods: The ACS-NSQIP dataset was queried for patients who underwent open or laparoscopic ventral hernia repairs, by primary procedure CPT codes, between years 2009-2012. Smoking use was registered as defined by the ACS-NSQIP, as both a current smoker (within the prior 12 months) or as a history of smoking (having ever smoked). Univariate and multivariate analyses were used to investigate postoperative complications for 30-day morbidity and mortality by smoking status while adjusting for preoperative risk factors.

Results: A total of 72,350 patients met inclusion; the majority of cases were open, 82%, compared to laparoscopic 18%. Sex was evenly distributed with 58% female and 42% male. More current smokers existed in the open vs laparoscopic cohort (p=.0001). There was a similar distribution of patients with any history of smoking favoring open (p=.01).  When using Fisher’s exact test, there were significantly more respiratory complications (p=.0003) and infectious complications (p=1.2×10-6). When controlling for sex, age, and type of surgery, using logistic regression, there were associations between smoking in the prior 12 months and respiratory complications, including pneumonia (p=3.4×10-15), re-intubation (p=9.0×10-12), and failure to wean (p=5.7×10-11).  Similar associations were seen on logistic regression if a patient ever smoked; including pneumonia (p=3.4×10-15), re-intubation (p=6.9×10-14), and failure to wean (p=1.8×10-10). 

Conclusion: Smoking tobacco, both current and historical use, leads to an increase in both respiratory and infectious complications. As more centers try to pre-operatively condition patients for elective hernia repairs it is important to note that patients may never return to the baseline outcomes of patients who never smoked.