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Smoking and Postoperative Complications in Plastic and General Surgical Procedures: A Propensity Score–Matched Analysis of 294,903 Patients from the National Surgical Quality Improvement Program Database from 2005 to 2014

Fu, Rose H., M.D.; Toyoda, Yoshiko, B.A.; Li, Lu, M.S.; Baser, Onur, M.S., Ph.D.; Rohde, Christine H., M.D.; Otterburn, David M., M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1633-1643
doi: 10.1097/PRS.0000000000005008
Plastic Surgery Focus: Special Topics
Outcomes: Prevention
Patient Safety CME

Background: Smoking as a risk factor for postoperative complications is more relevant in elective plastic surgery than in urgent general surgery. From 2005 to 2014, the U.S. smoking rate decreased from 20.9 percent to 16.8 percent. This study compares smoking prevalence in plastic and general surgery patients, and postoperative complications when smoking is isolated as an independent risk factor.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to examine smoking and 30-day postoperative complications for plastic and general surgery procedures. Patients were propensity score matched for demographics and comorbidities.

Results: The authors examined 294,903 patients from 2005 to 2014. The smoking rates in general surgery mirrored national trends (R = −0.85), whereas those in plastic surgery were significantly lower (p < 0.01). General surgery smokers were more comorbid and experienced more superficial surgical-site infections, pulmonary embolism, and myocardial infarction (p < 0.02) than general surgery nonsmokers. Plastic surgery smokers were not significantly different than plastic surgery nonsmokers. The general surgery cohort was more comorbid than the plastic surgery cohort. All smokers had increased dehiscence, deep surgical-site infection, and reoperation (p ≤ 0.01). Plastic surgery patients suffered more wound complications and bleeding than general surgery patients (p < 0.01).

Conclusions: This is the first propensity score–matched, large-scale database analysis isolating smoking as a risk factor for postoperative complications. Smoking may have different risk factor profiles for postoperative complications in plastic surgical versus general surgical patient populations, emphasizing the need for caution when generalizing general surgical evidence for use in the plastic surgical population.


Evidence-Based Outcomes Article.Patient Safety CME.

New York, N.Y.; and Plano, Texas

From New York-Presbyterian Hospital, Weill Cornell Medical Center, and the Center for Innovation and Outcomes Research, Columbia University Medical Center; and STATinMED Research.

Received for publication September 14, 2017; accepted April 9, 2018.

Presented in part at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, March 25 through 28, 2017; and Plastic Surgery The Meeting 2017, Annual Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, October 6 through 10, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to Dashboard, clicking “Submit CME,” and completing the form.

David M. Otterburn, M.D., Division of Plastic Surgery, New York-Presbyterian/Weill-Cornell Medical Center, 425 East 61st Street, 10th Floor, New York, N.Y. 10065,

Copyright © 2018 by the American Society of Plastic Surgeons