Howard Ryan, Ehlers Anne, Fry Brian, O'Neill Sean, Telem Dana, Shao Jenny
Division of Minimally Invasive Surgery, Section of General Surgery, Department of Surgery, University of Michigan, 2924B Taubman Center, SPC 5331, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5331, USA.
Surg Endosc. 2025 Sep 13. doi: 10.1007/s00464-025-12206-1.
Smoking has long been regarded as a contraindication to elective ventral hernia repair, however some have begun to question whether this practice is unnecessarily restrictive. In order to better understand the implications of more liberal patient selection for commonly encountered hernias, we evaluated outcomes among smokers and nonsmokers undergoing elective ventral hernia repair.
We retrospectively reviewed a population-level registry to identify adults who underwent elective ventral hernia repair between 2021 and 2023. The primary explanatory variable was active smoking, which was defined as smoking within the month prior to surgery. Outcomes included 30-day complications, emergency department utilization (including reason for utilization), readmission, and reoperation. Multivariable logistic regression was used to assess the association of smoking with all outcomes while controlling for patient, hernia, and operative characteristics.
12,233 patients underwent elective ventral hernia repair during the study period. Mean age was 54.3 (14.3) years, 5151 (42.1%) patients were female, and mean hernia width was 3.3 (3.2) cm. 2059 (16.8%) patients smoked prior to surgery. Smokers were younger, had higher ASA classifications, and more pulmonary disease. Regarding management, smokers were less likely to have myofascial release, but there was no difference in surgical approach or mesh use. Smoking was not associated with increased odds of 30-day complications, readmission, or reoperation. Smoking was associated with increased odds of 30-day ED utilization (6.83% [95% CI 5.76-7.90%] vs. 4.87% [95% CI 4.45-5.30%], P < 001), however this was due to pain-related issues (43.3% vs. 32.9%, P = 0.017) and not infectious or wound-related issues.
In this cohort of patients undergoing elective ventral hernia repair, management of smokers and nonsmokers was similar, and smokers did not have significantly worse short-term outcomes than nonsmokers. These findings may help inform patient selection and expectations, however long-term outcomes including recurrence require evaluation as well.
长期以来，吸烟一直被视为择期腹疝修补术的禁忌证，然而，一些人开始质疑这种做法是否限制过多。为了更好地理解对常见疝采用更宽松的患者选择标准的影响，我们评估了接受择期腹疝修补术的吸烟者和非吸烟者的治疗结果。
我们回顾性分析了一项人群水平的登记数据，以确定2021年至2023年间接受择期腹疝修补术的成年人。主要解释变量为当前吸烟，定义为手术前一个月内吸烟。观察指标包括30天并发症、急诊科就诊情况（包括就诊原因）、再次入院和再次手术。采用多变量逻辑回归分析评估吸烟与所有观察指标之间的关联，同时控制患者、疝和手术特征。
在研究期间，12233例患者接受了择期腹疝修补术。平均年龄为54.3（14.3）岁，5151例（42.1%）为女性，平均疝宽为3.3（3.2）cm。2059例（16.8%）患者术前吸烟。吸烟者更年轻，美国麻醉医师协会（ASA）分级更高，肺部疾病更多。在治疗方面，吸烟者接受肌筋膜松解术的可能性较小，但手术方式或补片使用方面无差异。吸烟与30天并发症、再次入院或再次手术的发生率增加无关。吸烟与30天内急诊科就诊几率增加有关（6.83%[95%CI 5.76 - 7.90%]对4.87%[95%CI 4.45 - 5.30%]，P<0.001），然而，这是由于疼痛相关问题（4比率为32.9%，P = 0.017），而非感染或伤口相关问题。
在这组接受择期腹疝修补术的患者中，吸烟者和非吸烟者的治疗方式相似，吸烟者的短期预后并不比非吸烟者明显更差。这些发现可能有助于指导患者选择和预期，但包括复发在内的长期预后也需要评估。
