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Smoking as a Perioperative Risk Factor in Plastic and General Surgical Procedures; Is There a Difference in Complication Profile? A Propensity-Score Matching Analysis of 294,903 Patients from the NSQIP Database
Rose H. Fu, MD, Yoshiko Toyota, BA, Lu Li, MS, Christine H. Rohde, MD, David Otterburn, MD.
New York Presbyterian/Cornell-Columbia, New York City, NY, USA.

PURPOSE:
Smoking is an established modifiable risk factor for perioperative complications. This is especially relevant in elective plastic surgical (PS) than in urgent general surgical (GS) procedures. From 2005 to 2014, smoking rate among U.S. adults decreased from 20.9% to 16.8%. This study compares smoking prevalence in patients undergoing plastic and general surgical procedures, and the postoperative complication profile when smoking is isolated as an independent risk factor. METHODS:
We used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to examine smoking and 30-day postoperative complications for plastic and general surgical procedures. Patients were propensity matched for demographics and comorbidities to isolate smoking and minimize confounders. RESULTS:
We examined 294,903 patients from 2005-2014. Smoking rates in GS followed the national trend (R=0.85). Rates in PS were significantly lower (p<0.01). GS smokers had more comorbidities than respective nonsmokers. After propensity matching, GS cohort had less wound complications than PS cohort (p-value). Neither GS nor PS smokers had increased bleeding, graft failure, sepsis, or DVT compared to nonsmokers. Superficial surgical site infections (SSI)(p<0.01), PE (p<0.01) and MI (p=0.02) were increased for GS compared to non-smokers but not for PS smokers. Both PS and GS smokers had increased incisional dehiscence, deep SSI and return to OR (p<0.01). CONCLUSION: The contrast in smoking rates between GS and PS highlights the differences in patient selection for urgent versus elective procedures. Our data suggests smoking may have a different risk factor profile for postoperative complications between PS and GS patient populations.


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