American Association for Hand Surgery

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The effect of smoking on complications following hand surgery
Brian H Cho, MD1, Keith T Aziz, MD1 and Aviram M Giladi, MD, MS2, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)The Curtis National Hand Center, Baltimore, MD


Smoking is a prevalent modifiable risk factor that has been associated with many adverse postoperative outcomes across numerous surgical specialties. In this study, we examine the impact of smoking on short term (30-day) complications in patients undergoing hand surgery procedures.


Materials and Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data sets were queried for all patients who underwent hand surgery from 2011 to 2016. Hand surgery procedures were categorized as either trauma-related or elective. Cohorts were divided into smoking and nonsmoking and compared in terms of demographic characteristics, comorbidities, and postoperative complications. Multivariable logistic regression models were used to control for patient demographics and comorbidities in assessing the association between smoking and post-operative major and minor complications.



Of the 48,370 patients who underwent hand surgery from 2011 to 2016, 22% (N=10,577) of patients reported active smoking. Compared to nonsmokers, smokers were more likely to be younger (45 vs. 53 years, P<0.05), male (55% vs. 42%, P<0.05), and have a lower body mass index (26.9 vs. 27.8, P<0.05). Additionally, they were more likely to have a higher American Society of Anesthesiologists (ASA) classification (2.1 vs. 1.9, P<0.05), and report dyspnea (P<0.05) and chronic obstructive pulmonary disease (COPD) (P<0.05). Multivariable logistic regression identified an independent association between smoking and major complications (odds ratio; 1.34, 95% CI, 1.09-1.63; P<0.05) and infection (odds ratio; 1.37, 95% CI, 1.14-1.64; P<0.05). Smoking was not associated with other minor complications (odds ratio; 1.09, 95% CI, 0.89-1.33, P=0.40). Sub-group analysis identified that for trauma-related procedures, smoking was associated with major complications (odds ratio; 1.38, 95% CI, 1.09-1.75; p<0.05). In patients who underwent elective hand surgery procedures, smoking was not associated with an increased risk for minor, major, or infectious complications.



A substantial proportion of patients undergoing hand surgery are smokers. These patients may be at a significantly higher odds of major complications and infections than nonsmokers. Smoking status and cessation remains an important discussion topic during the preoperative consultation before hand surgery.


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