da Silveira Carlos André Balthazar, Rasador Ana Caroline, Lima Diego L, Kasmirski Julia, Kasakewitch João P G, Nogueira Raquel, Malcher Flavio, Sreeramoju Prashanth
Bahiana School of Medicine and Public Health, Bahia, Brazil.
Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Hernia. 2024 Dec;28(6):2079-2095. doi: 10.1007/s10029-024-03122-9. Epub 2024 Jul 31.
Individual studies indicate poorer outcomes for smokers after hernia repair. Previous meta-analyses have examined the impact of smoking on specific outcomes such as recurrence and surgical site infection, but there has been a lack of comprehensive consensus or systematic review on this subject. Addressing this gap, our study undertakes a systematic review and meta-analysis to assess the impact of smoking on the outcomes of ventral hernia repair (VHR) and inguinal hernia repair.
A thorough search of Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE, focusing on studies that examined the effect of smoking on inguinal and VHR outcomes was conducted. Key outcomes evaluated included recurrence, reoperation, surgical site occurrences (SSO), surgical site infection (SSI), and seroma.
Out of 3296 screened studies, 42 met the inclusion criteria. These comprised 25 studies (69,295 patients) on VHR and 17 studies (204,337 patients) on inguinal hernia repair. The analysis revealed that smokers had significantly higher rates of recurrence (10.4% vs. 9.1%; RR 1.48; 95% CI [1.15; 1.90]; P < 0.01), SSO (13.6% vs. 12.7%; RR 1.44; 95% CI [1.12; 1.86]; P < 0.01) and SSI (6.6% vs. 4.2%; RR 1.64; 95% CI [1.38; 1.94]; P < 0.01) following VHR. Additionally, smokers undergoing inguinal hernia repair showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P < 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P < 0.001), and chronic pain (9.9% vs. 10%; RR 1.24; 95% CI [1.06; 1.45]; P < 0.01) rates. No significant differences were observed in seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084) and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR, and in reoperation rates (RR 0.99; 95% CI [0.51; 1.91]; P = 0.978) for inguinal hernias between smokers and non-smokers. Analysis using funnel plots and Egger's test showed the absence of publication bias in the study outcomes.
This comprehensive meta-analysis found statistically significant increases in recurrence rates, and immediate postoperative complications, such as SSO and SSI following inguinal and VHR. Also, our subgroup analysis suggests that the MIS approach seems to be protective of adverse outcomes in the smokers group. However, our findings suggest that these findings are not of clinical relevance, so our data do not support the necessity of smoking cessation before hernia surgery. More studies are needed to elucidate the specific consequences of smoking in both inguinal and ventral hernia repair.
ID CRD42024517640.
个别研究表明，吸烟者疝气修补术后的预后较差。以往的荟萃分析研究了吸烟对复发和手术部位感染等特定结局的影响，但在这一主题上缺乏全面的共识或系统评价。为填补这一空白，我们的研究进行了一项系统评价和荟萃分析，以评估吸烟对腹疝修补术（VHR）和腹股沟疝修补术结局的影响。
对Cochrane Central、Scopus、SciELO和PubMed/MEDLINE进行了全面检索，重点关注研究吸烟对腹股沟疝和VHR结局影响的研究。评估的主要结局包括复发、再次手术、手术部位事件（SSO）、手术部位感染（SSI）和血清肿。
在3296项筛选的研究中，42项符合纳入标准。其中包括25项关于VHR的研究（69295例患者）和17项关于腹股沟疝修补术的研究（204337例患者）。分析显示，吸烟者VHR术后复发率（10.4%对9.1%；RR 1.48；95%CI[1.15；1.90]；P<0.01）、SSO发生率（13.6%对12.7%；RR 1.44；95%CI[1.12；1.86]；P<0.01）和SSI发生率（6.6%对4.2%；RR 1.64；95%CI[1.38；1.94]；P<0.01）显著更高。此外，接受腹股沟疝修补术的吸烟者复发率（9%对8.7%；RR 1.91；95%CI[1.21；3.01]；P<0.01）、SSI发生率（0.6%对0.3%；RR 1.6；95%CI[1.21；2.0]；P<0.001）和慢性疼痛发生率（9.9%对10%；RR 1.24；95%CI[1.06；1.45]；P<0.01）更高。吸烟者和非吸烟者在VHR的血清肿发生率（RR 2.63；95%CI[0.88；7.91]；P=0.084）和再次手术率（RR 1.48；95%CI[0.77；2.85]；P=0.236）以及腹股沟疝的再次手术率（RR 0.99；95%CI[0.51；1.91]；P=0.978）方面未观察到显著差异。使用漏斗图和Egger检验进行的分析表明，研究结果不存在发表偏倚。
这项全面的荟萃分析发现，腹股沟疝和VHR术后复发率以及诸如SSO和SSI等术后即刻并发症在统计学上显著增加。此外，我们的亚组分析表明，MIS方法似乎对吸烟者组的不良结局具有保护作用。然而，我们的研究结果表明，这些发现不具有临床相关性，因此我们的数据不支持疝气手术前戒烟的必要性。需要更多研究来阐明吸烟在腹股沟疝和腹疝修补术中的具体后果。
PROSPERO注册：ID CRD42024517640。
