Study on Active Smoking and 30-Day Wound Events post Minimally Invasive Inguinal Hernia Repair

This study by Ivy N. Haskins, MD, analyzes the association between active smoking and 30-day wound events following minimally invasive inguinal hernia repair. It explores the necessity and feasibility of preoperative smoking cessation, involving a detailed analysis of 2,652 inguinal hernia repairs, matched analysis criteria, and results comparing smokers and non-smokers.

• Smoking
• Inguinal hernia repair
• Wound events
• Active smokers
• Preoperative cessation

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1. Association of Active Smoking and 30-Day Wound Events following Minimally Invasive Inguinal Hernia Repair Ivy N. Haskins, MD, DABOM, FACS, FASMBS Co-Director, Esophageal Swallowing Center Assistant Professor of Surgery University of Nebraska Medical Center Omaha, NE

2. INTRODUCTION Preoperative Optimization Smoking cessation S rensen Surface area, proximity of mesh

3. 800,000 Inguinal Hernia Repairs INTRODUCTION 100,000 Inguinal Hernia Repairs 700,000 Inguinal Hernia Repairs Is preoperative smoking cessation necessary? Is preoperative smoking cessation realistic?

4. PURPOSE Association of active smoking at the time of MIS inguinal hernia repair and 30- day wound events ACHQC Database

5. METHODS INCLUSION CRITERIA EXCLUSION CRITERIA Emergent Elective Open Laparoscopic or robotic-assisted Hepatic insufficiency or ascites present Smoking status not available Unilateral or bilateral Smoking status available 30-day follow-up data available 30-day follow-up data not available

6. METHODS 1:1 matched analysis Variables used for matching: Age, Gender, BMI, Surgical Approach, Mesh Type, Hernia Size, HTN, CHF, COPD, Dyspnea, Dialysis, Diabetes, Antiplatelet Medication, History of AAA, Collagen Vascular Disorder, Immunosuppressants Active smokers within 30 days of surgery to non-smokers (at least > 1 year prior to surgery)

7. 2,652 Inguinal Hernia Repairs RESULTS 1,326 Inguinal Hernia Repairs 1,326 Inguinal Hernia Repairs

8. RESULTS Active Smoker N = 1,326 Non-Smoker N = 1,326 p-value Operative Time 0-59 60-119 120-179 180-239 > 240 Unilateral Hernia 592 (44.6%) 591 (44.6%) 118 (8.9%) 12 (1.1%) 11 (0.8%) 607 (45.8%) 588 (44.3%) 104 (7.8%) 20 (1.5%) 7 (0.5%) 0.55 903 (68.1%) 914 (68.9%) 0.65 Left Indirect Hernia Size <1.5 cm 1.5 3 cm > 3 cm Left Direct Hernia Size <1.5 cm 1.5 3 cm > 3 cm 165 (12.4%) 284 (21.4%) 121 (9.1%) 153 (11.5%) 262 (19.8%) 132 (10.0%) 0.69 78 (5.9%) 179 (13.5%) 63 (4.8%) 98 (7.4%) 172 (13.0%) 62 (4.7%) 0.55

9. RESULTS Active Smoker N = 1,326 Non-Smoker N = 1,326 p-value Left Femoral Hernia Size <1.5 cm 1.5 3 cm > 3 cm Right Indirect Hernia Size <1.5 cm 1.5 3 cm > 3 cm Right Direct Hernia Size <1.5 cm 1.5 3 cm > 3 cm Right Femoral Hernia Size <1.5 cm 1.5 3 cm > 3 cm 29 (2.2%) 14 (1.1%) 2 (0.2%) 35 (2.6%) 12 (0.9%) 0 0.58 167 (12.6%) 361 (27.2%) 160 (12.2%) 162 (12.2%) 355 (26.8%) 168 (12.7%) 0.99 109 (8.2%) 184 (13.9%) 81 (6.1%) 108 (8.1%) 204 (15.4%) 66 (5.0%) 0.63 38 (2.9%) 17 (1.3%) 2 (0.2%) 40 (3.0%) 12 (0.9%) 3 (0.2%) 0.89

10. RESULTS Active Smoker N = 1,326 Non-Smoker N = 1,326 p-value Left Inguinal Scrotal 85 (12.2%) 58 (8.4%) 0.02 Right Inguinal Scrotal 98 (11.8%) 80 (9.5%) 0.13 Mesh Type Used Biologic Permanent Synthetic Resorbable Synthetic Unknown 8 (0.6%) 1312 (98.9%) 3 (0.2%) 3 (0.2%) 5 (0.4%) 1317 (99.3%) 2 (0.2%) 2 (0.2%) 0.74 Mesh Fixation 969 (73.1%) 946 (71.3%) 0.32 Left Fixation Type Self-fixating mesh Suture Tacks Adhesive Staples 233 (17.6%) 257 (19.4%) 292 (22.0%) 47 (3.5%) 16 (1.2%) 220 (16.6%) 236 (17.8%) 280 (21.2%) 57 (4.3%) 16 (1.2%) 0.50 0.29 0.57 0.32 1 Right Fixation Type Self-fixating mesh Suture Tacks Adhesive Staples 285 (21.5%) 292 (22.0%) 334 (25.2%) 71 (5.4%) 25 (1.9%) 252 (19.0%) 291 (21.9%) 341 (25.7%0 75 (5.7%) 10 (0.8%) 0.11 0.96 0.76 0.73 0.01

11. RESULTS Active Smoker N = 1,326 4 (0.3%) Non-Smoker N = 1,326 0 p-value Surgical Site Infection Surgical Site Occurrence Surgical Site Occurrence Requiring Procedural Intervention 0.12 93 (7.0%) 65 (4.9%) 0.02 6 (0.5%) 2 (0.2%) 0.29

12. RESULTS Active Smoker N = 1,326 3 (0.2%) 7 (0.5%) 8 (0.6%) Non-Smoker N = 1,326 5 (0.4%) 10 (0.8%) 4 (0.3%) p-value Hernia Recurrence 30-Day Readmission 30-Day Reoperation 0.73 0.45 0.26

13. CONCLUSION Smoking at the Time of MIS Inguinal Hernia Repair Wound Events Long-Term Data Needed