Stop smoking a month before an event cure allows you to reach the results of non-smokers despite more complex interventions. A study on more than 1,000 operated patients validates this preoperative recommendation.
The event cure constitutes a common intervention in general surgery, but its failures (recurrence) and complications generate discomfort, lasting sequelae and significant additional costs for the health system.
The preoperative identification of risk factors for failure is a major issue to optimize surgical results. Among these factors, smoking occupies a special place because it can be modified: previous studies have established the benefit of its judgment in the month preceding the intervention, in particular on the reduction of operations of operating site in orthopedic and gynecological surgery.
Beyond the parietal complications (wall abscesses), smoke patients have a high impact of postoperative respiratory complications after ripper, resulting in a significant extension of the length of hospitalization compared to non-smokers. However, the precise rate of these respiratory complications in this population remains insufficiently documented.
A prospective database, more than 1,000 operated
Charlotte authors (North Carolina) interviewed a prospective institutional database including data from all interventions for reconstruction of the abdominal wall between 2012 and 2019. The evaluation focused on 1,088 patients, 305 of which had ceased to smoke at least a month before the Event Cure and 783 who had never smoked. The main evaluation criteria were complications related to wounds and respiratory tract in these two groups; The secondary evaluation criterion was recurrence.
The veracity of smoking abstinence has been verified by a cotinine urinary test. All interventions have used the same technique consisting in placing a pre-peritoneal trellis.
Different populations for comparable results
The characteristics of the patients of the two groups were different. Non-smokers were on average younger (58 versus 60 years), more often women (57 % vs 47 %), with a higher body mass index (32.7 vs 31.3 kg/m²), less often with chronic obstructive bronchopneumopathy (4 % vs 9 %) and they presented an ASA III score less often (American Society of Anaesthesiologists) – testifying to a generally serious but non -disabling disease – (34.5 % vs 51,5 %).
The operating duration was comparable in both groups although the parietal deficit has proven to be more extensive in patients who had been weaned tobacco avant l’intervention (229 vs 209,1 ​cm2; P = 0.023), which also more often required the use of a technique for separating components (52.5 % vs 43.8%; P = 0.010) and biological plates.
If the length of stay was slightly extended in the smoking withdrawal group (6.6 days vs 6.2 days; P = 0.0015), there was no significant difference between parietal or respiratory complications.
Admittedly, the costs have been heavier in the smoking withdrawal group, but this can be attributed to the need for more expensive prostheses and sometimes delayed surgery.
The recurrence rate (around 3 %) during 16 -month follow -up was similar in the two groups.
In multivariate analysis, unlike other risk factors for failure (such as body mass index, diabetes, chronic obstructive bronchopneumopathy), the status of ancient smoker or non-smoking has had no impact on the consequences of the Event Cure.
