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Introduction <p>Active smoking is widely regarded as a risk factor for wound morbidity and adverse outcomes in abdominal wall reconstruction (AWR), often serving as a contraindication to elective repair. However, its independent impact on long-term complications remains poorly characterized.</p> Methods <p>This study utilized the prospectively maintained ACHQC registry, included patients who underwent open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh at a high-volume AWR center between February 2019 and December 2022. All active smokers during this period were propensity matched in a 1:3 ratio to never-smokers based on demographics, comorbidities, and operative characteristics. Outcomes were assessed at early (30-day) and long-term (≥ 24 months) timepoints. Primary endpoints included wound morbidity, mesh-related complications and hernia recurrence.</p> Results <p>A total of 106 active smokers were propensity-matched to 295 never-smokers. Baseline demographics and operative variables were well balanced. At 30 days, there were no significant differences in surgical site infection (SSI) (9.4% vs. 9.2%, <i>p</i> = 0.92), surgical site occurrence (SSO) (21.5% vs. 17.6%, <i>p</i> = 0.48), or surgical site occurrence requiring procedural intervention (SSOPI) (9.4% vs. 9.2%, <i>p</i> = 0.92). At 24 months, rates of SSO (1.9% vs. 0.7%, <i>p</i> = 0.81), SSI (0% vs. 0.3%, <i>p</i> &gt; 0.99), SSOPI (0% vs. 0.7%, <i>p</i> &gt; 0.99), mesh infection (0.9% vs. 0%, <i>p</i> &gt; 0.99), and reoperation were low and statistically similar. Hernia recurrence at ≥ 24 months was 4.7% in smokers vs. 7.8% in never-smokers (<i>p</i> = 0.15).</p> Conclusion <p>In this analysis, active smoking was not associated with increased risk of clinically significant wound morbidity, mesh-related complications, SSOPI, or hernia recurrence. These findings support a patient-centered approach wherein smoking cessation is strongly encouraged but not mandated prior to surgical repair in appropriately selected individuals.</p>

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The impact of active smoking on postoperative morbidity and hernia recurrence following abdominal wall reconstruction: long-term follow-up

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月27日

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  • Nir Messer,
  • Adar Horowitz,
  • Benjamin T. Miller,
  • Lucas R. A. Beffa,
  • Clayton C. Petro,
  • Ajita S. Prabhu,
  • Li-Ching Huang,
  • Eliad Karin,
  • Fahim Kanani,
  • Eran Nizri,
  • Guy Lahat,
  • Amir Szold,
  • Michael J. Rosen

摘要

Introduction

Active smoking is widely regarded as a risk factor for wound morbidity and adverse outcomes in abdominal wall reconstruction (AWR), often serving as a contraindication to elective repair. However, its independent impact on long-term complications remains poorly characterized.

Methods

This study utilized the prospectively maintained ACHQC registry, included patients who underwent open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh at a high-volume AWR center between February 2019 and December 2022. All active smokers during this period were propensity matched in a 1:3 ratio to never-smokers based on demographics, comorbidities, and operative characteristics. Outcomes were assessed at early (30-day) and long-term (≥ 24 months) timepoints. Primary endpoints included wound morbidity, mesh-related complications and hernia recurrence.

Results

A total of 106 active smokers were propensity-matched to 295 never-smokers. Baseline demographics and operative variables were well balanced. At 30 days, there were no significant differences in surgical site infection (SSI) (9.4% vs. 9.2%, p = 0.92), surgical site occurrence (SSO) (21.5% vs. 17.6%, p = 0.48), or surgical site occurrence requiring procedural intervention (SSOPI) (9.4% vs. 9.2%, p = 0.92). At 24 months, rates of SSO (1.9% vs. 0.7%, p = 0.81), SSI (0% vs. 0.3%, p > 0.99), SSOPI (0% vs. 0.7%, p > 0.99), mesh infection (0.9% vs. 0%, p > 0.99), and reoperation were low and statistically similar. Hernia recurrence at ≥ 24 months was 4.7% in smokers vs. 7.8% in never-smokers (p = 0.15).

Conclusion

In this analysis, active smoking was not associated with increased risk of clinically significant wound morbidity, mesh-related complications, SSOPI, or hernia recurrence. These findings support a patient-centered approach wherein smoking cessation is strongly encouraged but not mandated prior to surgical repair in appropriately selected individuals.