Prospective study of skin surgery in smokers vs. nonsmokers

A. J. Dixon, M. P. Dixon, J. B. Dixon, C. B. Del Mar

Research output: Contribution to journalArticleResearchpeer-review

21 Citations (Scopus)

Abstract

Background: Smoking may increase complications following minor surgery leading many clinicians to urge patients to refrain from smoking before and after surgery. Objective: To study the association between smoking and complications following skin surgery. Methods: In a 5-year prospective observational study 7224 lesions were excised on 4197 patients. Patients were not instructed regarding smoking. All complications were recorded. Results: A total of 439 smokers (10.5%) underwent 646 procedures (9%), 3758 nonsmokers (89.5%) underwent 6578 procedures (91%). Smokers were younger (55 ± 16 years) than nonsmokers (66 ± 17 years) (P <0.001). Infection incidence was not significantly different, 1.9% (12/646) in smokers compared with 2.2% (146/6578) in nonsmokers (P = 0.55). There were two bleeds with smokers (0.3%) vs. 50 in nonsmokers (0.8%) (P = 0.2). The incidence of wound dehiscence in nonsmokers (three) was not different from nonsmokers (21) (P = 0.54). However, the incidence of scar contour distortion in smokers (three) was greater than in nonsmokers (two) (odds ratio 15.3; 95% confidence interval 2.5-92). Total complication incidence was similar, 3.6% in smokers vs. 4.0% in nonsmokers (P = 0.58). Out of 2371 flaps there were 14 (0.6%) cases of end-flap necrosis but smokers were not at increased risk. The case-control analysis compared each smoker with two nonsmokers matched for age, sex, postal code and outdoor occupational exposure. This again demonstrated no difference in infection, scar complication, bleed, dehiscence, end-flap necrosis or total complication incidence. Conclusions: Smokers and nonsmokers suffer skin surgery complications similarly. The increased risk of contour distortion identified was difficult to interpret. Advice to cease smoking in the short term to improve outcomes with skin cancer surgery is not supported by these data.
Original languageEnglish
Pages (from-to)365-367
Number of pages3
JournalBritish Journal of Dermatology
Volume160
Issue number2
DOIs
Publication statusPublished - 1 Feb 2009

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Dermatologic Surgical Procedures
Smoking
Prospective Studies
Incidence
Cicatrix
Necrosis
Minor Surgical Procedures
Skin Neoplasms
Occupational Exposure
Infection
Observational Studies
Odds Ratio
Confidence Intervals
Wounds and Injuries

Cite this

Dixon, A. J. ; Dixon, M. P. ; Dixon, J. B. ; Del Mar, C. B. / Prospective study of skin surgery in smokers vs. nonsmokers. In: British Journal of Dermatology. 2009 ; Vol. 160, No. 2. pp. 365-367.
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title = "Prospective study of skin surgery in smokers vs. nonsmokers",
abstract = "Background: Smoking may increase complications following minor surgery leading many clinicians to urge patients to refrain from smoking before and after surgery. Objective: To study the association between smoking and complications following skin surgery. Methods: In a 5-year prospective observational study 7224 lesions were excised on 4197 patients. Patients were not instructed regarding smoking. All complications were recorded. Results: A total of 439 smokers (10.5{\%}) underwent 646 procedures (9{\%}), 3758 nonsmokers (89.5{\%}) underwent 6578 procedures (91{\%}). Smokers were younger (55 ± 16 years) than nonsmokers (66 ± 17 years) (P <0.001). Infection incidence was not significantly different, 1.9{\%} (12/646) in smokers compared with 2.2{\%} (146/6578) in nonsmokers (P = 0.55). There were two bleeds with smokers (0.3{\%}) vs. 50 in nonsmokers (0.8{\%}) (P = 0.2). The incidence of wound dehiscence in nonsmokers (three) was not different from nonsmokers (21) (P = 0.54). However, the incidence of scar contour distortion in smokers (three) was greater than in nonsmokers (two) (odds ratio 15.3; 95{\%} confidence interval 2.5-92). Total complication incidence was similar, 3.6{\%} in smokers vs. 4.0{\%} in nonsmokers (P = 0.58). Out of 2371 flaps there were 14 (0.6{\%}) cases of end-flap necrosis but smokers were not at increased risk. The case-control analysis compared each smoker with two nonsmokers matched for age, sex, postal code and outdoor occupational exposure. This again demonstrated no difference in infection, scar complication, bleed, dehiscence, end-flap necrosis or total complication incidence. Conclusions: Smokers and nonsmokers suffer skin surgery complications similarly. The increased risk of contour distortion identified was difficult to interpret. Advice to cease smoking in the short term to improve outcomes with skin cancer surgery is not supported by these data.",
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Prospective study of skin surgery in smokers vs. nonsmokers. / Dixon, A. J.; Dixon, M. P.; Dixon, J. B.; Del Mar, C. B.

In: British Journal of Dermatology, Vol. 160, No. 2, 01.02.2009, p. 365-367.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Dixon, J. B.

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N2 - Background: Smoking may increase complications following minor surgery leading many clinicians to urge patients to refrain from smoking before and after surgery. Objective: To study the association between smoking and complications following skin surgery. Methods: In a 5-year prospective observational study 7224 lesions were excised on 4197 patients. Patients were not instructed regarding smoking. All complications were recorded. Results: A total of 439 smokers (10.5%) underwent 646 procedures (9%), 3758 nonsmokers (89.5%) underwent 6578 procedures (91%). Smokers were younger (55 ± 16 years) than nonsmokers (66 ± 17 years) (P <0.001). Infection incidence was not significantly different, 1.9% (12/646) in smokers compared with 2.2% (146/6578) in nonsmokers (P = 0.55). There were two bleeds with smokers (0.3%) vs. 50 in nonsmokers (0.8%) (P = 0.2). The incidence of wound dehiscence in nonsmokers (three) was not different from nonsmokers (21) (P = 0.54). However, the incidence of scar contour distortion in smokers (three) was greater than in nonsmokers (two) (odds ratio 15.3; 95% confidence interval 2.5-92). Total complication incidence was similar, 3.6% in smokers vs. 4.0% in nonsmokers (P = 0.58). Out of 2371 flaps there were 14 (0.6%) cases of end-flap necrosis but smokers were not at increased risk. The case-control analysis compared each smoker with two nonsmokers matched for age, sex, postal code and outdoor occupational exposure. This again demonstrated no difference in infection, scar complication, bleed, dehiscence, end-flap necrosis or total complication incidence. Conclusions: Smokers and nonsmokers suffer skin surgery complications similarly. The increased risk of contour distortion identified was difficult to interpret. Advice to cease smoking in the short term to improve outcomes with skin cancer surgery is not supported by these data.

AB - Background: Smoking may increase complications following minor surgery leading many clinicians to urge patients to refrain from smoking before and after surgery. Objective: To study the association between smoking and complications following skin surgery. Methods: In a 5-year prospective observational study 7224 lesions were excised on 4197 patients. Patients were not instructed regarding smoking. All complications were recorded. Results: A total of 439 smokers (10.5%) underwent 646 procedures (9%), 3758 nonsmokers (89.5%) underwent 6578 procedures (91%). Smokers were younger (55 ± 16 years) than nonsmokers (66 ± 17 years) (P <0.001). Infection incidence was not significantly different, 1.9% (12/646) in smokers compared with 2.2% (146/6578) in nonsmokers (P = 0.55). There were two bleeds with smokers (0.3%) vs. 50 in nonsmokers (0.8%) (P = 0.2). The incidence of wound dehiscence in nonsmokers (three) was not different from nonsmokers (21) (P = 0.54). However, the incidence of scar contour distortion in smokers (three) was greater than in nonsmokers (two) (odds ratio 15.3; 95% confidence interval 2.5-92). Total complication incidence was similar, 3.6% in smokers vs. 4.0% in nonsmokers (P = 0.58). Out of 2371 flaps there were 14 (0.6%) cases of end-flap necrosis but smokers were not at increased risk. The case-control analysis compared each smoker with two nonsmokers matched for age, sex, postal code and outdoor occupational exposure. This again demonstrated no difference in infection, scar complication, bleed, dehiscence, end-flap necrosis or total complication incidence. Conclusions: Smokers and nonsmokers suffer skin surgery complications similarly. The increased risk of contour distortion identified was difficult to interpret. Advice to cease smoking in the short term to improve outcomes with skin cancer surgery is not supported by these data.

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