title: Postoperative Wound Infections After Breast Reductions: The Role of Smoking and the Amount of Tissue Removed Wound Infections in Aesthetic Abdominoplasties: The Role of Smoking The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Influence of smoking and alcohol consumption on admissions and duration of hospitalization. Less collagen production in smokers. Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery. Definitive risk factors for anastomotic leaks in elective open colorectal resection. Risk factors for complications after carotid endarterectomy--a population-based study. Smoking-related morbidity and mortality following liver transplantation. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Risk factors for surgical-site infections in head and neck cancer surgery A multivariate analysis of the risk of pulmonary complications after laparotomy. Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Lack of correlation between smoking status and early postoperative outcome following valve surgery. Risk factors for deep surgical site infections after spinal fusion Substance Use Among Iranian Cardiac Surgery Patients and Its Effects on Short-Term Outcome Smoking is not a predictor of mortality and morbidity following coronary artery bypass grafting. Risk Factors for Infection After Spinal Surgery Identifying risk factors for potentially avoidable complications following radical cystectomy. Mortality and morbidity after surgery of mid and low rectal cancer. Results of a French prospective multicentric study. Cigarette smoking and flap and full-thickness graft necrosis. Risk Factors for Postoperative Spinal Wound Infections After Spinal Decompression and Fusion Surgeries Derivation and Diagnostic Accuracy of the Surgical Lung Injury Prediction Model Crucial aspects of smoking in wound healing after breast reduction surgery. Preoperative smoking habits and postoperative pulmonary complications. Wound complications after hand assisted laparoscopic surgery. A Prospective Assessment of Surgical Risk Factors in 400 Cases of Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Implants to Establish Selection Criteria
abstract: Background This prospect i ve study followed patients who underwent breast reductions  to determine the influence of smoking and the amount of tissue removed on postoperative wound infections . Methods Patients who had received breast reductions were considered eligible for the study . The study excluded postbariatric patients and those with ongoing clinical infections , a recent antibiotic course , or systemic diseases that could impair tissue oxygenation . Smokers were instructed to quit smoking at least 4 weeks before surgery . Results By March 2004 , the study had enrolled 87 patients .  Postoperative infections were present in 24 cases ( 27.9 % ) . Infections included 16 in smokers ( 37.2 % ) , 8 in nonsmokers ( 18.2 % ; p < 0.05 ) , 14 in patients with large resections ( > 0.85 kg ; 70 % ) , and 10 in patients with small resections ( 14.9 % ; p < 0.001 ) . Significant differences were found between the patients who experienced infections and those who were infection free in terms of the overall estimated cigarettes smoked ( mean , 146,000 ; range , 29,200–228,125 vs mean , 10,950 ; range , 9,125–54,750 ; p < 0.001 ) , the number of pack years ( mean , 20 ; range , 4–31 vs mean , 2 ; range , 1–8 ; p < 0.001 ) , and the amount of tissue removed ( mean , 0.9 kg ; range , 0.5–2 kg vs mean , 0.5 kg ; range , 0.2–1.4 kg ; p < 0.001 ) . The analysis for all the patients determined an odds ratio of 2.04 for smoking and 4.7 for the amount of tissue removed . Conclusions Smoking and the amount of tissue removed are important issues in aesthetic breast surgery that need to be addressed accurately by the plastic surgeon . If future larger studies confirm these data , surgeons could have a simple and easy method for stratifying patients according to their risk for the development of wound infections and for prescribing specific preventive measures Background : In this prospect i ve study , the authors followed patients who underwent aesthetic abdominoplasty  to determine the influence of smoking on the occurrence of postoperative wound infections . Methods : Patients who underwent aesthetic abdominoplasty were considered eligible for the study . The authors excluded postbariatric patients , those with ongoing clinical infections , those receiving a recent antibiotic course , and those with systemic diseases such as arteriosclerosis and diabetes mellitus . Smokers were advised to quit smoking at least 4 weeks before surgery . Results : Starting in February of 2004 , the authors enrolled 84 patients .  Postoperative infections were present in 13 patients ( 15.5 percent ) and were superficial in 10 ( 77 percent ) . All but one occurred in smokers . These had a certain number of cigarettes smoked per day , years of smoking , and higher estimated overall number of smoked cigarettes when postoperative infections were present . The relative risk of smoking on infections was 12 . A cutoff value of approximately 33,000 overall cigarettes smoked determined 3.3 percent false-positive and 0 percent false-negative rates . Conclusions : Smoking is an important issue in aesthetic surgery that needs to be accurately addressed during the preoperative interview . In the future , the analysis of smoke-related , easy-to-gather variables such as the estimated overall number of cigarettes smoked until surgery could help stratify patients according to their risk of manifesting infections Background The extent to which lifestyle factors such as tobacco consumption and obesity affect the outcome after inguinal hernia surgery has been poorly studied . This study was undertaken to assess the effect of smoking , smokeless tobacco consumption and obesity on postoperative complications after inguinal hernia surgery . The second aim was to evaluate the effect of tobacco consumption and obesity on the length of hospital stay . Methods A cohort of 12,697 Swedish construction workers with prospect ively collected exposure data on tobacco consumption and body mass index ( BMI ) from 1968 onward were linked to the Swedish inpatient register . Information on inguinal hernia procedures was collected from the inpatient register . Any postoperative complication occurring within 30 days was registered . In addition to this , the length of hospitalization was calculated . The risk of postoperative complications due to tobacco exposure and BMI was estimated using a multiple logistic regression model and the length of hospital stay was estimated in a multiple linear regression model . Results After adjusting for the other covariates in the multivariate analysis , current smokers had a 34 % ( OR 1.34 , 95 % CI 1.04 , 1.72 ) increased risk of postoperative complications compared to never smokers . Use of “ Swedish oral moist snuff ” ( snus ) and pack-years of tobacco smoking were not found to be significantly associated with an increased risk of postoperative complications . BMI was found to be significantly associated with an increased risk of postoperative complications ( P = 0.04 ) . This effect was mediated by the underweighted group ( OR 2.94 ; 95 % CI 1.15 , 7.51 ) . In a multivariable model , increased BMI was also found to be significantly associated with an increased mean length of hospital stay ( P < 0.001 ) . There was no statistically significant association between smoking or using snus , and the mean length of hospitalization after adjusting for the other covariates in the model . ConclusionS moking increases the risk of postoperative complications even in minor surgery such as inguinal hernia procedures . Obesity increases hospitalization after inguinal hernia surgery . The Swedish version of oral moist tobacco , snus , does not seem to affect the complication rate after hernia surgery at all BACKGROUND Previous studies have linked smoking and alcohol consumption to a considerable disease burden and large healthcare expenditures . However , findings from studies based on individual level data are sparse and inconclusive . Our objective was to assess the association between alcohol consumption , smoking and patterns of hospitalization , defined as admission and duration of hospitalization . METHODS The study was based on 12 698 men and women , aged 20 years or more , enrolled in the Copenhagen City Heart Study . We related  smoking and alcohol  to hospital admission from any cause , smoking- and alcohol-related diseases and duration of hospitalization in a two-part r and om effects model . RESULTS Smoking status was strongly associated with admission and duration of hospitalization . For smoking-related admissions , odds ratios ( OR ) of 2.77 ( 95 % CI 2.13 - 3.59 ) in men and 6.30 ( 95 % CI 4.80 - 8.26 ) in women were observed among smokers of > 20 g/day compared to never-smokers . For any admission ( excl . smoking-related causes ) , corresponding ORs were 1.32 ( 95 % CI 1.15 - 1.51 ) and 1.80 ( 95 % CI 1.58 - 2.06 ) , respectively . In men , a U-shaped association between alcohol consumption and risk of admission was found , both regarding any admission and admissions due to alcohol-related diseases . Alcohol was associated with alcohol-related admissions in women but not with duration of hospitalization . CONCLUSIONS Smoking was associated with increased risk of hospital admission and duration of hospitalization . A U-shaped relation was observed for alcohol consumption and risk of hospitalization in men , but no effect on duration was observed . In women , however , alcohol consumption was only vaguely associated with admission and duration of hospitalization BACKGROUND An association between smoking and impaired wound healing has been reported in retrospective studies . The smoking status of a surgical patient may be confounded by social and medical parameters . We have evaluated the effect of smoking in a test wound in volunteers , with special reference to a reliable scientific match between smokers and nonsmokers . METHODS In a prospect i ve open study with blinded assessment , 19 smoking ( 20 cigarettes/day ) and 18 nonsmoking healthy volunteers were matched with respect to baseline characteristics . The deposition of total protein and mature collagen ( expressed as hydroxyproline ) was assessed in an exp and ed polytetrafluoroethylene wound healing model implanted subcutaneously for 10 days . RESULTS The nonsmokers had a 1.8 times higher median amount of hydroxyproline than the smokers ( p < 0.01 ) . The deposition of hydroxyproline was negatively correlated with the consumption of tobacco both before ( r = -0.44 ; p < 0.01 ) and during the study ( r = -0.48 ; p < 0.005 ) . The impairment was specific for the production of collagenous proteins and not other proteins . CONCLUSIONS The synthesis of subcutaneous collagen in smokers is specifically impeded , indicating an impaired wound-healing process . Because mature collagen is the main determinator of strength of an operative wound , the results support the view that patients should be advised to stop smoking before an operation BACKGROUND Coughing during emergence from general anaesthesia may be detrimental , particularly after cervical spine surgery . We compared the effect of propofol or sevoflurane anaesthesia on the incidence and severity of coughing during recovery in patients undergoing cervical spine surgery via an anterior approach . As a secondary aim , we also evaluated the influences of smoking and estimated residual anaesthetic agent concentrations on coughing . METHODS Thirty-four patients were enrolled in a r and omized prospect i ve , double-blind study to receive either propofol ( PPF ) or sevoflurane ( SEVO ) for maintenance of anaesthesia . The decision to perform tracheal extubation was based on specified criteria , including resumption of spontaneous respiration and consciousness . During emergence from anaesthesia and extubation , coughing was observed and grade d at predefined times . RESULTS The incidence of severe coughing was higher in the SEVO group than in the PPF group ( 59 % and 6 % , respectively ) , and also in smokers than in non-smokers ( 50 % and 17 % , respectively ) . The peak incidence of coughing was at tracheal extubation . The probability of coughing was influenced by the estimated residual concentration of anaesthetic agents at extubation , except for smokers in the SEVO group who were at the highest risk of coughing . CONCLUSIONS The incidence of coughing after cervical spine surgery when tracheal extubation is performed according to clinical criteria is lower after propofol anaesthesia compared with sevoflurane anaesthesia . Smokers are at increased risk of coughing , independently of the type of anaesthesia maintenance . Higher residual concentrations of anaesthetic agents decrease the probability of coughing , except for smokers anaesthetized with sevoflurane HYPOTHESIS Anastomotic leaks following elective colorectal resections increase morbidity , mortality , and the need for additional interventions . An accurate underst and ing of risk factors would potentially reduce anastomotic leaks and /or allow appropriate selection of patients for diverting stomas . DESIGN Prospect i ve review of patient and operative characteristics that contribute to anastomotic leaks . SETTING Fifty-one sites within the United States ( May 2002-March 2005 ) . PATIENTS Six hundred seventy-two patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery .  MAIN OUTCOME MEASURES Anastomotic leaks were diagnosed using clinical findings and were confirmed with imaging . We examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses . RESULTS There were 24  anastomotic leaks in 672 patients ( 3.6 % ) undergoing elective colorectal resection . There were 10 deaths ( 1.5 % ) . A baseline albumin level of less than 3.5 g/dL ( to convert to grams per liter , multiply by 10 ) ( P = .04 ) and male sex ( P = .03 ) were associated with anastomotic leaks in both univariate and multivariate analyses ( adjusted odds ratios , 2.56 and 3.12 , respectively ) . Increased duration of surgery ( SD , 60 minutes ; odds ratio , 1.53 ; 95 % confidence interval , 1.06 - 2.22 ; P = .03 ) and steroid use at the time of surgery ( odds ratio , 3.85 ; 95 % confidence interval , 1.24 - 11.93 ; P = .02 ) were significant in univariate analysis . Surgical procedure with rectal resection ; prophylaxis with ertapenem ( vs cefotetan ) ; or history of obesity , tobacco use , or diabetes was not associated with anastomotic leaks . CONCLUSIONS Significant risk factors for anastomotic leaks include low preoperative serum albumin level , steroid use , male sex , and increased duration of surgery . Appreciation of risk factors provides a rational basis for temporary diversion OBJECTIVES The overall benefit of  carotid endarterectomy ( CEA )  is dependent on the outcome from the procedure . However , many reports are from selected centres and not population -based . The aim of this study was to assess the 30-day complication rate for a whole country and also to determine independent risk factors for serious complications . MATERIAL S AND METHODS One thous and five hundred and eighteen CEA were retrospectively review ed , covering principally all the CEAs in Sweden , during a three year period . Indications for surgery were ; minor stroke 34 % , TIA 34 % , amaurosis fugax 18 % , asymptomatic 11 % and others 3 % . Data were collected from the Swedish Vascular Registry ( Swedvasc ) . Combined cohort and case-control methodology was used . RESULTS Registered complications were ; 43 permanent strokes , 32 transient strokes ( < 30 days ) , 18 TIA/amaurosis fugax and 22 deaths ( seven fatal stokes ) . In the cohort study , the 30-day permanent stroke and death rate were 4.3 % ( 65/1518 ) . Significant risk factors in multivariate analyses were the indication for surgery ( minor stroke vs. other indications ) ( p=0.02 , RR=1.38 ) , diabetes ( p=0.02 , RR=1.41 ) , cardiac disease ( p<0.01 , RR 1.43 ) and operation at a university hospital ( p=0.02 , RR=1.39 ) . In the case-control study comparing the 65 cases of permanent stroke and /or death with 130 matched controls the only significant risk factor was contralateral occlusion ( p<0.01 , OR=5.27 ) . One patient ( 1/130 ) with a permanent stroke was wrongly reported as a local neurological complication ( facial paresis ) . CONCLUSION This national audit demonstrated population -based data on complication rates after CEA well comparable with previous r and omised trials . The validity of the Swedvasc data was confirmed . Combined cohort and case-control methodology was useful in analysing risk factors for serious perioperative complications Smoking is the world 's leading cause of premature mortality responsible for an estimated 5 million deaths each year . Although the negative health implication s of cigarette smoking in the nontransplant setting are well recognized , the effect on patient and graft survival post liver transplantation remains unclear . The aim of this study was therefore to assess the influence of smoking on morbidity and mortality following liver transplantation . We performed a retrospective single-center case-note study of 136 consecutive patients who underwent elective liver transplantation between January 1 , 1996 and December 31 , 2000 . Patients were defined as active smokers ( 23 % ) , exsmokers ( 18 % ) , or life-long nonsmokers ( 58 % ) on the basis of documentation at the time of transplant assessment . Active smoking was associated with increased all-cause mortality post transplant , with estimated 1- , 5- , and 10-year survival of 94 % , 68 % , and 54 % , respectively , versus 94 % , 83 % , and 77 % for nonsmokers ( P = 0.04 ) . A multivariate Cox proportional hazards model identified smoking as an independent predictor of death ( hazard ratio 2.23 , 95 % confidence interval 1.08 - 4.61 , P = 0.03 ) . Active smokers demonstrated increased cardiovascular-specific mortality ( P = 0.01 ) and sepsis-specific mortality ( P = 0.02 ) but not malignancy-related mortality ( P = 0.61 ) and had graft survival similar to that of nonsmokers ( P = 0.88 ) . Exsmokers did not have an increased risk of death ( P = 0.134 ) . In conclusion , active smokers at time of assessment have increased mortality post liver transplantation , which is non-graft-related and appears to be a result of increased cardiovascular-related and sepsis-related death . Prospect i ve studies are required to assess the impact of smoking cessation on long-term outcome Background Postoperative pulmonary complications ( PPC ) are the most frequently observed complications following lung resection , of which pneumonia and atelectasis are the most common . PPCs have a significant clinical and economic impact associated with increased observed number of deaths , morbidity , length of stay and associated cost . The aim of this study was to assess the incidence and impact of PPCs and to identify potentially modifiable independent risk factors . Methods A prospect i ve observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 13 months .  PPC was assessed using a scoring system based on chest x-ray , raised white cell count , fever , microbiology , purulent sputum and oxygen saturations . Results Thirty-four of 234 subjects ( 14.5 % ) had clinical evidence of PPC . The PPC patient group had a significantly longer length of stay ( LOS ) in hospital , high dependency unit ( HDU ) LOS , higher frequency of intensive care unit ( ITU ) admission and a higher number of hospital deaths . Older patients , body mass index ( BMI ) ≥30 kg/m2 , preoperative activity < 400 m , American Society of Anesthesiologists ( ASA ) score ≥3 , smoking history , chronic obstructive pulmonary disease ( COPD ) , lower preoperative forced expiratory volume in 1 s ( FEV1 ) and predicted postoperative ( PPO ) FEV1 were all significantly ( p<0.05 ) associated with PPC on univariate analysis . Multivariate analysis confirmed that age > 75 years , BMI ≥30 kg/m2 , ASA ≥3 , smoking history and COPD were significant independent risk factors in the development of PPC ( p<0.05 ) . Conclusion The clinical impact of PPCs is marked . Significant independent preoperative risk factors have been identified in current clinical practice . Potentially modifiable risk factors include BMI , smoking status and COPD . The impact of targeted therapy requires further evaluation Objective The aim of this study was to identify risk factors for surgical-site infections ( SSIs ) in patients with head and neck cancer su bmi tted to major clean-contaminated surgery . Study Design This is a prospect i ve study conducted in a tertiary cancer center hospital . Subjects and Methods This study includes 258 patients su bmi tted to a major clean-contaminated head and neck oncologic surgery .  Results The overall SSI rate was 38.8 % . The univariate analysis showed the following significant risk factors : race , tobacco consumption , clinical stage , comorbidities , time duration of the surgical procedure , and flap reconstruction . The final model by logistic regression identified the following independent predictors for SSI : tobacco consumption ( odds ratio [ OR ] = 2.96 ) , presence of metastatic lymph nodes ( OR = 2.05 ) , flap reconstruction ( OR = 2.20 ) , and antimicrobial prophylaxis exceeding 48 hours ( OR=1.89 ) . Conclusion The high-risk patients for SSI in head and neck oncologic surgery were those with cancer at advanced stages , those who were smokers , those presenting comorbidities , those who needed major reconstruction of the surgical wound , or those who were su bmi tted to inadequate antibiotic prophylaxis We evaluated the relationship between PPC and various putative risk factors in a prospect i ve longitudinal study of 1,000 patients undergoing abdominal surgery .  Transient sub clinical events were excluded by defining PPC as positive clinical findings in combination with either positive sputum microbiology , unexplained pyrexia , or positive chest roentgenographic findings . The overall incidence of PPC was 23.2 percent ( 232/1,000 ) . Multivariate analysis identified seven factors which were associated with PPC : ASA classification greater than 2 , upper abdominal surgery , residual intraperitoneal sepsis , age greater than 59 years , BMI greater than 25 , preoperative hospital stay greater than 4 days , and colorectal or gastroduodenal surgery ( overall F score = 33.5 , p less than 0.0001 ) . The ASA classification was the most powerful indicator of risk in both the univariate and the multivariate analyses . The combination of ASA classification greater than 1 and age greater than 59 years identified 88 percent ( 205 of 232 ) of the patients who developed PPC . These findings provide clinicians and clinical investigators with a simple means of identifying patients who are at high risk of PPC after abdominal surgery QUESTION Can the risk of developing postoperative pulmonary complications be predicted after  upper abdominal surgery ? DESIGN Prospect i ve observational study . PARTICIPANTS 268 consecutive patients undergoing elective upper abdominal surgery who received st and ardised pre- and postoperative prophylactic respiratory physiotherapy .  OUTCOME MEASURES Predictors were 17 preoperative and intraoperative risk factors . A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present : radiological evidence of collapse/consolidation , temperature > 38 degrees C , oxyhaemoglobin saturation < 90 % , abnormal sputum production , sputum culture indicating infection , raised white cell count , abnormal auscultation findings , or physician 's diagnosis of pulmonary complication . RESULTS 35 participants ( 13 % ) developed postoperative pulmonary complications . Five risk factors predicted postoperative pulmonary complications : duration of anaesthesia ( OR 4.3 , 95 % CI 1.7 to 10.8 ) ; surgical category ( OR 2.3 , 95 % CI 1.1 to 4.7 ) ; current smoking ( OR 2.1 , 95 % CI 1.0 to 4.5 ) ; respiratory co-morbidity ( OR 2.1 , 95 % CI 1.0 to 4.4 ) ; and predicted maximal oxygen uptake ( OR 2.0 , 95 % CI 1.0 to 4.3 ) . A clinical rule for predicting the development of postoperative pulmonary complications predicted 82 % of participants who developed complications . The odds of high risk participants developing pulmonary complications were 8.4 ( 95 % CI 3.3 to 21.3 ) times that of low risk participants . CONCLUSION This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy . Further research is needed to vali date the rule BACKGROUND We sought to assess the effect of smoking on early outcome following valve surgery . METHODS This is a retrospective review of a prospect ively collected departmental data base of all patients who underwent isolated aortic and /or mitral valve surgery ( replacement and /or repair ) . Our cohort consisted of 590 patients stratified into three groups :  current smokers  ( n = 94 ) ,  ex-smokers  ( n = 243 ) , and nonsmokers ( n = 253 ) . RESULTS There were no significant differences in the in-hospital mortality between the three groups . Likewise , the length of both hospital and intensive care unit stays were similar among the three groups with a similar rate of postoperative complications . These findings remained statistically not significant , even after adjusting for potential confounders such as age , gender , etc . CONCLUSION Smoking does not seem to be associated with an increased early postoperative risk in patients undergoing valve surgery . However , because of the known effect of smoking on the risk of cardiovascular disease and because the effect of smoking on long-term survival in patients undergoing valve surgery remains unknown , patients should still be encouraged to quit smoking Surgical site infections ( SSI ) are undesired and troublesome complications after spinal surgery . The reported infection rates range from 0.7 to 11.9 % , depending on the diagnosis and the complexity of the procedure . Besides operative factors , patient characteristics could also account for increased infection rates . Because the medical , economic and social costs of SSI are enormous , any significant reduction in risks will pay dividends . The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a r and omly selected group of patients who did not develop this complication in order to identify changeable risk factors . With a case – control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008 , we identified 36 cases with deep SSI ( CDC criteria ) . Information regarding patient-level and surgical-level risk factors was derived from st and ardized but routinely recorded data and compared with those acquired in a r and om selection of 135 uninfected patients . Univariate analyses and a multivariate logistic regression were performed . The overall rate of infection in 1,615 procedures ( 1,568 patients ) was 2.2 % . A positive history of spinal surgery was associated with an almost four times higher infection rate ( OR = 3.7 , 95 % BI = 1.6–8.6 ) . The risk of SSI increased with the number of levels fused , patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI . The most common organism cultured was Staphylococcus aureus . All infected patients underwent at least one reoperation , including an open débridement and received appropriate antibiotics to treat the organism . Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery . Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways . High-risk patients should be informed about the increased risk of complications BACKGROUND : We assessed the prevalence of substance use among patients undergoing coronary artery bypass graft and valve surgery in northwest Iran . We evaluated the postoperative complications and in-hospital mortality of patients with substance dependence and abuse . METHODS : In this prospect i ve , observational study , we interviewed 600 patients during the preoperative visit in a tertiary referral educational hospital in northwest Iran . The definition of substance abuse and dependence was according to DSM-IV criteria . Postoperative complications and in-hospital mortality of patients with substance ( cigarette , opium , and alcohol ) dependence and abuse were compared with those in control patients who did not use these substances . RESULTS : In 600 studied patients , the prevalence of  cigarette smoking was 42.1 % ( ex-smokers 26.0 % and current smokers 16.1 % ) , prevalence of opium use was 12.0 % ( opium abuse 7.0 % and opium dependence 5.0 % ) , and alcohol consumption was 8.1 % ( alcohol abuse 7.4 % and alcohol dependence 0.7 % ) . The prevalence of cigarette smoking was 58.9 % in men and 7.6 % in women ( P = 0.001 ) . Postoperative cardiac complications in current smokers ( 21.5 % ) and ex-smokers ( 20.5 % ) were not significantly different from the control group ( 28.2 % ) . Also , pulmonary complications were not different in current smokers ( 24.7 % ) and ex-smokers ( 17.9 % ) from the control group ( 26.8 % ; P = 0.196 ) . However , in men , pulmonary complications in current smokers were more prevalent than in the control group ( P = 0.044 ) . In opium and alcohol dependents and abusers , postoperative complications were not statistically different from the control group ( all P values > 0.05 ) . No increase was observed regarding in-hospital mortality in patients with substance use . CONCLUSIONS : In cardiac surgery patients in northwest Iran , the prevalence of cigarette smoking is relatively low ( very low in women ) , as is alcohol use , compared with Western countries ; however , opium use is twice as prevalent . We found higher pulmonary complication rates in men who smoked , but no increase in postoperative cardiopulmonary complications and in-hospital mortality rates in patients who abused opium and consumed alcohol BACKGROUND The objective of this study was to determine the significant differences in preoperative and operative characteristics , and postoperative outcomes in patients having coronary artery bypass grafting ( CABG ) who are smokers and in those who are not smokers . METHODS Data were collected prospect ively in all ( 2916 ) patients having their first CABG .  The patients were cared for in a regional medical center by private physicians . No operations were denied because of smoking status . Smokers differed from nonsmokers in several characteristics . RESULTS Analysis of morbidity and mortality showed no instance in which smokers fared worse than nonsmokers . Stepwise logistic regression analysis showed that smoking was not predictive of mortality . Smoking was not predictive of morbidity except that it was predictive of less probability of need for intra-aortic balloon pump ( 7.5 % in nonsmokers and 4.7 % in smokers ) . We then created groups of smokers and nonsmokers that were individually matched for age and sex . Analysis of the matched groups of smokers and nonsmokers showed that there was no significant difference in the incidence or magnitude of preoperative and operative factors except that recent myocardial infa rct ion was more common in smokers . Nonsmokers had greater weight , body mass index ( obesity ) , and ejection fraction . There was no difference in smokers and nonsmokers in mortality or morbidity at the 99 % confidence level . CONCLUSION We conclude that there is no need to delay CABG for the patients who are smokers Study Design . A retrospective case control analysis of 48 cases of postoperative infection following spinal procedures .  Objectives . Spinal procedures that became infected after surgery were analyzed to identify the significance of preoperative and intraoperative risk factors . Characterization of the nature and timing of the infections was also performed . Summary of Background Data . The rate of postoperative infection following  spinal surgery  varies widely depending on the nature of the procedure and the patient ’s diagnosis . Preoperative comorbidities and risk factors also influence the likelihood of infection . Methods . A review of 1629 procedures performed on 1095 patients revealed that a postoperative infection  developed in 48 patients ( 4.4 % ) . Data regarding preoperative and intraoperative risk factors were gathered from patient charts for these and a r and omly selected control group of 95 uninfected patients . For analysis , these patient groups were further divided into adult and pediatric subgroups , with an age cutoff of 18 years . Preoperative risk factors review ed included smoking , diabetes , previous surgery , previous infection , steroid use , body mass index , and alcohol abuse . Intraoperative factors review ed included staging of procedures , estimated blood loss , operating time , and use of allograft or instrumentation . Results . The majority of infections occurred during the early postoperative period ( less than 3 months ) . Age > 60 years , smoking , diabetes , previous surgical infection , increased body mass index , and alcohol abuse were statistically significant preoperative risk factors . The most likely procedure to be complicated by an infection was a combined anterior/posterior spinal fusion performed in a staged manner under separate anesthesia . Infections were primarily monomicrobial , although 5 patients had more than 4 organisms identified . The most common organism cultured from the wounds was Staphylococcus aureus . All patients were treated with surgical irrigation and débridement , and appropriate antibiotics to treat the cultured organism . Conclusions . Aggressive treatment of patients undergoing complex or prolonged spinal procedures is essential to prevent and treat infections . Underst and ing a patient ’s preoperative risk factors may help the physician to optimize a patient ’s preoperative condition . Additionally , awareness of critical intraoperative parameters will helpto optimize surgical treatment . It may be appropriate to increase the duration of prophylactic antibiotics or implement other measures to decrease the incidence of infection for high risk patients PURPOSE  Morbidity after radical cystectomy  is common and associated with increased health care re source use . Accurate characterization of complications after cystectomy , associated patient specific risk factors , and perioperative processes of care are essential to directing changes in perioperative management that will reduce morbidity and improve the quality of patient care . MATERIAL S AND METHODS The National Surgical Quality Improvement Program ( NSQIP ) is a prospect i ve quality management initiative of 123 Veterans Affairs Medical Centers nationwide . The NSQIP collects clinical information , intraoperative data and outcomes on a wide variety of surgical procedures from multiple surgical disciplines . Since 1991 , 2,538 radical cystectomy procedures have been captured by the NSQIP . Modeling using logistic regression was performed to identify patient specific risk factors and perioperative process measures associated with postoperative morbidity . RESULTS Of the 2,538 subjects at least 1 postoperative complication developed in 774 ( 30.5 % ) . The most frequent complication was ileus ( 10 % ) . Several factors were associated with the development of a complication , including age , dependent functional status , preoperative dyspnea , preoperative acute renal failure , chronic steroid use , preoperative alcohol consumption , American Society of Anesthesiology score , use of general anesthetic , operative time , intraoperative blood requirement and surgeon level of training . CONCLUSIONS Morbidity remains high after cystectomy with 30.5 % of subjects experiencing at least 1 complication . Measurable patient specific risk factors and perioperative processes associated with postoperative morbidity following cystectomy are now delineated which allows for improved risk stratification , patient counseling , and the development of novel processes that may incrementally reduce risk and improve outcomes BACKGROUND The aim of the study was to assess both mortality and morbidity following resection of mid and low rectal cancers in a French prospect i ve multicentric study . PATIENTS From June to September 2002 , consecutive patients undergoing resection for cancer of the mid- or lower rectum were prospect ively included in a multicentric study . Both postoperative mortality and morbidity were recorded . Multivariate statistical analysis was performed in order to assess risk factors predictive of postoperative morbidity . RESULTS 238 patients with a mean age of 66 + /- 13 years ( range : 26 - 88 ) were included .  Neoadjuvant radiotherapy was performed in 68 % of the patients . Total mesorectal excision was performed in 218 patients ( 92 % ) , of whom 151 ( 63 % ) had a sphincter saving procedure . Six patients died ( 2.5 % ) . Overall postoperative morbidity rate was 43 % , including anastomotic leakage ( 11 % ) and reoperation ( 5 % ) . Mean hospital-in-stay was 20 + /- 16 days ( range : 3191 ) . Four independent risk factors of morbidity were found : perioperative fecal contamination ( OR = 3.9 [ 1.1 ; 13.5 ] ) , mean operating time longer than 6 hours ( OR = 4.5 [ 1.7 ; 12.1 ] ) , ASA score > 2 ( OR = 3.2 [ 1.6 ; 7.9 ] ) , and smocking ( OR = 3.3 [ 1.2 ; 8.9 ] ) . CONCLUSIONS Resection of cancer involving the middle or lower rectum with sphincter saving procedures was possible in two-thirds of the patients and was associated with 2.5 % mortality and 43 % morbidity The association between cigarette smoking and necrosis of flaps and full-thickness grafts was analyzed in 220 patients . Review of a series of 916 flaps and full-thickness grafts revealed 44 patients in whom some degree of tissue necrosis occurred . These patients with necrosis were age and gender matched with 176 controls r and omly selected from the remaining 872 patients . Current high-level smokers , that is those smoking one or more packs per day , had necrosis develop approximately three times more frequently than never smokers , low-level smokers ( less than one pack per day ) , or former smokers ( 95 % confidence interval , 1.2 to 8.2 ) . Former smokers ( relative risk , 1.4 ; 95 % confidence interval , 0.6 to 3.2 ) and low-level smokers ( relative risk , 1.1 ; 95 % confidence interval , 0.2 to 6.1 ) were at a negligible increased risk for necrosis that was not significantly different from never smokers . Once tissue necrosis developed , the median percent of the visible flap or graft tissue that necrosed was approximately threefold greater among current smokers ( regardless of the number of packs per day smoked ) than never smokers Study Design . This is a multivariate analysis of a prospect ively collected data base . Objective . To determine preoperative , intraoperative , and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing spinal surgery .  Summary of Background Data . Current literature sites a postoperative infection rate of approximately 4 % ; however , few have completed multivariate analysis to determine factors which contribute to risk of infection . Methods . Our study identified patients who underwent a spinal decompression and fusion between 1997 and 2006 from the Veterans Affairs ’ National Surgical Quality Improvement Program data base .  Multivariate logistic regression analysis was used to determine the effect of various preoperative variables on postoperative infection . Results . Data on 24,774 patients were analyzed .  Wound infection was present in 752 ( 3.04 % ) patients , 287 ( 1.16 % ) deep , and 468 ( 1.89 % ) superficial . Postoperative infection was associated with longer hospital stay ( 7.12 vs. 4.20 days ) , higher 30-day mortality ( 1.06 % vs. 0.5 % ) , higher complication rates ( 1.24 % vs. 0.05 % ) , and higher return to the operating room rates ( 37 % vs. 2.45 % ) . Multivariate logistic regression identified insulin dependent diabetes ( odds ratios [ OR ] = 1.50 ) , current smoking ( OR = 1.19 ) ASA class of 3 ( OR = 1.45 ) or 4 to 5 ( OR = 1.66 ) , weight loss ( OR = 2.14 ) , dependent functional status ( 1.36 ) preoperative HCT < 36 ( 1.37 ) , disseminated cancer ( 1.83 ) , fusion ( OR = 1.24 ) and an operative duration of 3 to 6 hours ( OR = 1.33 ) or > 6 hours ( OR = 1.40 ) as statistically significant predictors of postoperative infection . Conclusion . Using multivariate analysis of a large prospect ively collected data from the National Surgical Quality Improvement Program data base , we identified the most important risk factors for increased postoperative spinal wound infection . We have demonstrated the high mortality , morbidity , and hospitalization costs associated with postoperative spinal wound infections . The information provided should help alert clinicians to presence of these risks factors and the likelihood of higher postoperative infections and morbidity in spinal surgery patients Background :  Acute lung injury ( ALI )  is a serious postoperative complication with limited treatment options . A preoperative risk-prediction model would assist clinicians and scientists interested in ALI . The objective of this investigation was to develop a surgical lung injury prediction ( SLIP ) model to predict risk of postoperative ALI based on readily available preoperative risk factors . Methods : Secondary analysis of a prospect i ve cohort investigation including adult patients undergoing high-risk surgery . Preoperative risk factors for postoperative ALI were identified and evaluated for inclusion in the SLIP model . Multivariate logistic regression was used to develop the model . Model performance was assessed with the area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test . Results : Out of 4,366 patients , 113 ( 2.6 % ) developed early postoperative ALI . Predictors of postoperative ALI in multivariate analysis that were maintained in the final SLIP model included high-risk cardiac , vascular , or thoracic surgery , diabetes mellitus , chronic obstructive pulmonary disease , gastroesophageal reflux disease , and alcohol abuse . The SLIP score distinguished patients who developed early  postoperative ALI from those who did not with an area under the receiver operating characteristic curve ( 95 % CI ) of 0.82 ( 0.78–0.86 ) . The model was well calibrated ( Hosmer-Lemeshow , P = 0.55 ) . Internal validation using 10-fold cross-validation noted minimal loss of diagnostic accuracy with a mean ± SD area under the receiver operating characteristic curve of 0.79 ± 0.08 . Conclusions : Using readily available preoperative risk factors , we developed the SLIP scoring system to predict risk of early postoperative ALI BACKGROUND The aim of this study was to investigate the influence of cigarette smoking on wound-healing in patients undergoing breast reduction . METHODS In our prospect i ve study , 50 patients ( 25 smokers , 25 nonsmokers ) scheduled for breast reduction have been evaluated .  Urine cotinine levels  were measured to analyse perioperative smoking habits . Urine sample s were taken preoperatively and on the fourth postoperative day . Cotinine as a metabolite of nicotine allows precise evaluation of nicotine exposure . To assess the progress of woundhealing we classified secreting , instable , inflamed or necrotic wound conditions , which required a dressing after the tenth postoperative day as impaired wound healing . For statistical analysis non-parametrical tests for independent and dependent data were used . RESULTS Ten of 25 smokers presented impaired wound healing compared to 4 of 25 nonsmokers . The median cotinine level of smokers was 1964 (783/3963)ng/cc preoperatively and 432 (148/1695)ng/cc postoperatively . Nonsmokers had a preoperative cotinine level of 18 (7/37)ng/cc and 15 (4/34)ng/cc postoperatively . Smokers who developed impaired wound-healing showed higher levels of cotinine pre- ( 2117 ng/cc ) and especially postoperatively ( 485 ng/cc ) compared to smokers with regular woundhealing ( 1614 ng/cc and 389 ng/cc ) . Both differences in cotinine levels were statistically significant ( p=0.03 and p=0.02 ) . CONCLUSIONS The data of the present study confirm the negative effect of smoking on wound healing in patients undergoing breast reduction OBJECTIVE To examine the effect of preoperative smoking behavior on postoperative pulmonary complications . DESIGN Prospect i ve cohort study . SETTING The Veterans Administration Medical Center , Syracuse , NY . PARTICIPANTS Patients scheduled for noncardiac elective surgery ( n=410 ) . MEASUREMENTS AND RESULTS  Smoking status  was determined by self-report . Postoperative pulmonary complications were determined by systematic extraction of medical record data . Postoperative pulmonary complications occurred in 31 of 141 ( 22.0 % ) current smokers , 24 of 187 ( 12.8 % ) past smokers , and 4 of 82 ( 4.9 % ) never smokers . The odds ratio ( OR ) for developing a postoperative pulmonary complication for current smokers vs never smokers was 5.5 ( 95 % confidence interval [ CI ] , 1.9 to 16.2 ) and 4.2 ( 95 % CI , 1.2 to 14.8 ) after adjustment for type of surgery , type of anesthesia , abnormal chest radiograph , chronic cough , history of pulmonary disease , history of cardiac disease , history of COPD , education level , pulmonary function , body mass index , and age . Current smokers who reported reducing cigarette consumption  prior to surgery were more likely to develop a complication compared with those who did not ( adjusted OR=6.7 , 95 % CI , 2.6 to 17.1 ) . CONCLUSIONS Current smoking was associated with a nearly sixfold increase in risk for a postoperative pulmonary complication . Reduction in smoking within 1 month of surgery was not associated with a decreased risk of postoperative pulmonary complications PURPOSE  H and assisted laparoscopic surgery ( HALS )  provides benefits similar to st and ard laparoscopy but generally requires a larger incision . We assessed the nature of and risk factors for incisional complications after HALS . MATERIAL S AND METHODS All patients who underwent HALS at our institution from February 1997 through December 2003 were included in a prospect i ve and retrospective review to assess postoperative wound complications . Literature regarding wound complications associated with open surgery and st and ard laparoscopy was review ed . RESULTS A total of 424 consecutive procedures performed on 422 patients were evaluated . Postoperative HALS incision site complications included 29 infections ( 6.8 % ) , 15 hernias ( 3.5 % ) and 2 dehiscences ( 0.5 % ) . Multivariate logistic regression models revealed that HALS incision site hernias were associated with current or past tobacco smoking ( 6.0 % , p = 0.04 ) , with a trend toward significance for diabetes mellitus ( 14 % , p = 0.07 ) , male gender ( 5.3 % , p = 0.08 ) and renal failure ( 16 % , p = 0.08 ) . HALS incision site infections were associated with omission of perioperative antibiotics ( 13 % , p = 0.007 ) , obesity ( 12 % , p = 0.03 ) and increased operative time ( 252 vs 222 minutes in patients with and without infection , respectively , p = 0.001 ) . CONCLUSIONS Our findings suggest that wound infections and hernias occur less frequently with HALS than with open surgery , but more often than with st and ard laparoscopy . Certain patient comorbidities ( eg obesity ) , modifiable risk factors ( eg smoking status ) and procedural variables ( eg omission of perioperative antibiotics or length of procedure ) may adversely influence HALS wound complications . This information can be used to decide between HALS and st and ard laparoscopic approaches in particular patients Background : Although attempts have been made to identify the risk factors leading to complications after  combined skin-sparing mastectomy and immediate prosthetic breast reconstruction  , hardly any criteria are available to preoperatively distinguish patients in whom such an eventful postoperative course may be expected . Therefore , the authors wanted to establish which factors increase the risk of surgical complications to such a level as to adjust their indications for immediate breast reconstruction after skin-sparing mastectomy . Methods : The authors prospect ively studied the clinical relevance of six patient-related and nine procedure-related characteristics as potential risk factors for a complicated surgical outcome in 400 combined procedures in 309 patients by univariate and multivariate logistic regression analysis . Risk factors that proved significantly correlated with loss of implant by both analyses were accepted as clinical selection criteria that distinguish potential c and i date s with an unacceptably high risk of such loss . Results : Mild complications occurred significantly more often in patients who were older than the mean age of 43 years and in breasts that were more than average sized or operated on by a fellow in oncologic surgery . Implants were lost significantly more often in patients who were obese or smoked and in breasts that were more than average sized . Conclusions : The clinical ly relevant increase of risk of implant loss should lead to reluctance to perform combined skin-sparing mastectomy and immediate prosthetic breast reconstruction  in obese patients who smoke ( 32 percent loss ) and in those with more than average sized breasts ( 27 percent loss )
target: Preoperative smoking status was not observed to be associated with postoperative mortality , cardiovascular complications , bleedings , anastomotic leakage , or allograft rejection .
  CONCLUSIONS Preoperative smoking was found to be associated with an increased risk of the following postoperative complications : general morbidity , wound complications , general infections , pulmonary complications , neurological complications , and admission to the intensive care unit
background: OBJECTIVE To systematic ally review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type .
  BACKGROUND The conclusions of studies examining the association between preoperative smoking and postoperative complications are inconsistent , thus there is a need for a review and meta- analysis to summarize the existing evidence .