Cholecystectomy and wound complications: Smoking worsens risk

Background: In the United States, approximately 800, 000 cholecystectomies are performed annually. We sought to determine the influence of preoperative smoking on postcholecystectomy wound complication rates. Materials and methods: Using the National Surgical Quality Improvement Program database (2005-2011), patients aged ≥18 y who underwent elective open or laparoscopic cholecystectomy (LC) for benign gallbladder disease were identified using current procedural terminology codes. Multivariate regression was performed to determine the association between smoking status and wound complications, by surgical approach. Results: Of 143, 753 identifiedpatients, 128, 692 (89.5%)underwentLC, 27, 788 (19.3%)were active smokers, and 100, 710 (70.2%) were females. Active smokers were younger than nonsmokers (mean + standard deviation age: 44.2 (14.9) versus 51.6 (17.9) years); P < 0.001) and had fewer comorbidities. Within 30-d postcholecystectomy, woundcomplications were reported in 2011 (1.4%) patients. Compared with nonsmokers, active smokers demonstrated increased odds of woundcomplicationsafter bothopencholecystectomy (odds ratio 1.28; P=0.010)andLC(odds ratio 1.20; P = 0.020) after adjustment for demographic and clinical characteristics. Having wound complications increased the average postoperative length of stay by 2-4 d (P <0.001). Conclusions: Active smokers are more likely to develop wound complications after cholecystectomy, regardless of surgical approach. Occurrence of wound complications consequently increases postoperative length of stay. Smoking abstinence before cholecystectomy may reduce the burden associated with wound complications.