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Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Patients are often advised on smoking cessation prior to elective surgical interventions, but the impact of active smoking on paraesophageal hernia repair (PEHR) outcomes is unclear. The objective of this cohort study was to evaluate the impact of active smoking on short-term outcomes following PEHR.

Methods

Patients who underwent elective PEHR at an academic institution between 2011 and 2022 were retrospectively reviewed. The National Surgical Quality Improvement Program (NSQIP) database from 2010 to 2021 was queried for PEHR. Patient demographics, comorbidities, and 30-day post-operative data were collected and maintained in an IRB-approved database. Cohorts were stratified by active smoking status. Primary outcomes included rates of death or serious morbidity (DSM) and radiographically identified recurrence. Bivariate and multivariable regressions were performed, and p value < 0.05 was considered statistically significant.

Results

538 patients underwent elective PEHR in the single-institution cohort, of whom 5.8% (n = 31) were smokers. 77.7% (n = 394) were female, median age was 67 [IQR 59, 74] years, and median follow-up was 25.3 [IQR 3.2, 53.6] months. Rates of DSM (non-smoker 4.5% vs smoker 6.5%, p = 0.62) and hernia recurrence (33.3% vs 48.4%, p = 0.09) did not differ significantly. On multivariable analysis, smoking status was not associated with any outcome (p > 0.2). On NSQIP analysis, 38,284 PEHRs were identified, of whom 8.6% (n = 3584) were smokers. Increased DSM was observed among smokers (non-smoker 5.1%, smoker 6.2%, p = 0.004). Smoking status was independently associated with increased risk of DSM (OR 1.36, p < 0.001), respiratory complications (OR 1.94, p < 0.001), 30-day readmission (OR 1.21, p = 0.01), and discharge to higher level of care (OR 1.59, p = 0.01). No difference was seen in 30-day mortality or wound complications.

Conclusion

Smoking status confers a small increased risk of short-term morbidity following elective PEHR without increased risk of mortality or hernia recurrence. While smoking cessation should be encouraged for all active smokers, minimally invasive PEHR in symptomatic patients should not be delayed on account of patient smoking status.

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References

  1. Lebenthal A, Waterford SD, Fisichella PM (2015) Treatment and controversies in paraesophageal hernia repair. Front Surg 2:13. https://doi.org/10.3389/fsurg.2015.00013

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hosein S, Carlson T, Flores L, Armijo PR, Oleynikov D (2021) Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: a large national database analysis. Surg Endosc 35(1):423–428. https://doi.org/10.1007/s00464-020-07404-y

    Article  PubMed  Google Scholar 

  3. Jalilvand AD, Jones EL, Martin Del Campo SE, Perry KA (2020) Octogenarians exhibit quality of life improvement but increased morbidity after paraesophageal hernia repair. Am J Surg 219(6):958–962. https://doi.org/10.1016/j.amjsurg.2019.09.014

    Article  PubMed  Google Scholar 

  4. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236(4):492–500. https://doi.org/10.1097/00000658-200210000-00012. (discussion 500–501)

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sherrill W, Rossi I, Genz M, Matthews BD, Reinke CE (2021) Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes. Surg Endosc 35(7):3405–3411. https://doi.org/10.1007/s00464-020-07782-3

    Article  PubMed  Google Scholar 

  6. Kaplan JA, Schecter S, Lin MYC, Rogers SJ, Carter JT (2015) Morbidity and mortality associated with elective or emergency paraesophageal hernia repair. JAMA Surg 150(11):1094–1096. https://doi.org/10.1001/jamasurg.2015.1867

    Article  PubMed  Google Scholar 

  7. Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM (2022) Tobacco product use among adults—United States, 2020. MMWR Morb Mortal Wkly Rep 71(11):397–405. https://doi.org/10.15585/mmwr.mm7111a1

    Article  PubMed  PubMed Central  Google Scholar 

  8. Silverstein P (1992) Smoking and wound healing. Am J Med 93(1A):22S-24S. https://doi.org/10.1016/0002-9343(92)90623-j

    Article  CAS  PubMed  Google Scholar 

  9. Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43(10):1731–1737. https://doi.org/10.1016/j.jacc.2003.12.047

    Article  CAS  PubMed  Google Scholar 

  10. Sorensen LT, Karlsmark T, Gottrup F (2003) Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 238(1):1–5. https://doi.org/10.1097/01.SLA.0000074980.39700.31

    Article  PubMed  PubMed Central  Google Scholar 

  11. Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF (2007) Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204(6):1188–1198. https://doi.org/10.1016/j.jamcollsurg.2007.02.070

    Article  PubMed  Google Scholar 

  12. Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111(3):564–571. https://doi.org/10.1378/chest.111.3.564

    Article  CAS  PubMed  Google Scholar 

  13. Yang CK, Teng A, Lee DY, Rose K (2015) Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. J Surg Res 198(2):441–449. https://doi.org/10.1016/j.jss.2015.03.028

    Article  PubMed  Google Scholar 

  14. Jeong BH, Shin B, Eom JS et al (2014) Development of a prediction rule for estimating postoperative pulmonary complications. PLoS ONE 9(12):e113656. https://doi.org/10.1371/journal.pone.0113656

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Brajcich BC, Yuce TK, Merkow RP et al (2022) Association of preoperative smoking with complications following major gastrointestinal surgery. Am J Surg 223(2):312–317. https://doi.org/10.1016/j.amjsurg.2021.06.002

    Article  PubMed  Google Scholar 

  16. DeLancey JO, Blay E, Hewitt DB et al (2018) The effect of smoking on 30-day outcomes in elective hernia repair. Am J Surg 216(3):471–474. https://doi.org/10.1016/j.amjsurg.2018.03.004

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sharma A, Deeb AP, Iannuzzi JC, Rickles AS, Monson JRT, Fleming FJ (2013) Tobacco smoking and postoperative outcomes after colorectal surgery. Ann Surg 258(2):296–300. https://doi.org/10.1097/SLA.0b013e3182708cc5

    Article  PubMed  Google Scholar 

  18. Mavros MN, Athanasiou S, Alexiou VG, Mitsikostas PK, Peppas G, Falagas ME (2011) Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 35(11):2389–2398. https://doi.org/10.1007/s00268-011-1266-5

    Article  PubMed  Google Scholar 

  19. Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT (2005) Predictors of wound infection in ventral hernia repair. Am J Surg 190(5):676–681. https://doi.org/10.1016/j.amjsurg.2005.06.041

    Article  PubMed  Google Scholar 

  20. Kao AM, Arnold MR, Augenstein VA, Heniford BT (2018) Prevention and treatment strategies for mesh infection in abdominal wall reconstruction. Plast Reconstr Surg 142(3 Suppl):149S-155S. https://doi.org/10.1097/PRS.0000000000004871

    Article  CAS  PubMed  Google Scholar 

  21. Burcharth J (2014) The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J 61(5):B4846

    PubMed  Google Scholar 

  22. Parker SG, Mallett S, Quinn L et al (2021) Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis. BJS Open 5(2):zraa071. https://doi.org/10.1093/bjsopen/zraa071

    Article  PubMed  PubMed Central  Google Scholar 

  23. Soppe S, Slieker S, Keerl A, Muller MK, Wirsching A, Nocito A (2022) Emergency repair and smoking predict recurrence in a large cohort of ventral hernia patients. Hernia J Hernias Abdom Wall Surg 26(5):1337–1345. https://doi.org/10.1007/s10029-022-02672-0

    Article  CAS  Google Scholar 

  24. Ban KA, Minei JP, Laronga C et al (2017) American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg 224(1):59–74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029

    Article  PubMed  Google Scholar 

  25. Leaper DJ, Edmiston CE (2017) World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect 95(2):135–136. https://doi.org/10.1016/j.jhin.2016.12.016

    Article  CAS  PubMed  Google Scholar 

  26. Carmichael JC, Keller DS, Baldini G et al (2017) Clinical practice guidelines for enhanced recovery after colon and rectal surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60(8):761–784. https://doi.org/10.1097/DCR.0000000000000883

    Article  PubMed  Google Scholar 

  27. Fuglestad MA, Tracey EL, Leinicke JA (2021) Evidence-based prevention of surgical site infection. Surg Clin N Am 101(6):951–966. https://doi.org/10.1016/j.suc.2021.05.027

    Article  PubMed  Google Scholar 

  28. Graybill WS, Frumovitz M, Nick AM et al (2012) Impact of smoking on perioperative pulmonary and upper respiratory complications after laparoscopic gynecologic surgery. Gynecol Oncol 125(3):556–560. https://doi.org/10.1016/j.ygyno.2012.03.020

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wang VL, Jalilvand AD, Gupta A, Chen J, Vadlamudi C, Perry KA (2021) Tobacco use is not associated with increased risk of recurrent reflux 5 years after laparoscopic anti-reflux surgery. Surg Endosc 35(8):4771–4778. https://doi.org/10.1007/s00464-020-07956-z

    Article  PubMed  Google Scholar 

  30. Samaan JS, Mohan S, Toubat O et al (2021) Effects of smoking on bariatric surgery postoperative weight loss and patient satisfaction. Surg Endosc 35(7):3584–3591. https://doi.org/10.1007/s00464-020-07827-7

    Article  PubMed  Google Scholar 

  31. About ACS NSQIP. ACS. https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/about-acs-nsqip/. Accessed 24 Mar 2023

  32. Yuce TK, Ellis RJ, Merkow RP, Soper NJ, Bilimoria KY, Odell DD (2020) Post-operative complications and readmissions following outpatient elective Nissen fundoplication. Surg Endosc 34(5):2143–2148. https://doi.org/10.1007/s00464-019-07020-5

    Article  PubMed  Google Scholar 

  33. Sweigert PJ, Eguia E, Kothari AN et al (2019) Do prolonged operative times obviate the benefits associated with minimally invasive colectomy? Surgery 166(3):336–341. https://doi.org/10.1016/j.surg.2019.05.006

    Article  PubMed  Google Scholar 

  34. Schlottmann F, Strassle PD, Allaix ME, Patti MG (2017) Paraesophageal hernia repair in the USA: trends of utilization stratified by surgical volume and consequent impact on perioperative outcomes. J Gastrointest Surg Off J Soc Surg Aliment Tract 21(8):1199–1205. https://doi.org/10.1007/s11605-017-3469-z

    Article  Google Scholar 

  35. Latzko M, Borao F, Squillaro A, Mansson J, Barker W, Baker T (2014) Laparoscopic repair of paraesophageal hernias. JSLS 18(3):e2014.00009. https://doi.org/10.4293/JSLS.2014.00009

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tam V, Winger DG, Nason KS (2016) A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg 211(1):226–238. https://doi.org/10.1016/j.amjsurg.2015.07.007

    Article  PubMed  Google Scholar 

  37. Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P (2013) The effectiveness of a perioperative smoking cessation program: a randomized clinical trial. Anesth Analg 117(3):605–613. https://doi.org/10.1213/ANE.0b013e318298a6b0

    Article  PubMed  Google Scholar 

  38. Huen KH, Chowdhury R, Shafii SM et al (2015) Smoking cessation is the least successful outcome of risk factor modification in uninsured patients with symptomatic peripheral arterial disease. Ann Vasc Surg 29(1):42–49. https://doi.org/10.1016/j.avsg.2014.09.014

    Article  PubMed  Google Scholar 

  39. Fay KA, Phillips JD, Hasson RM, Fannin A, Millington TM, Finley DJ (2020) Outcomes of an intensive, preoperative smoking cessation program. Ann Thorac Surg 109(2):e137–e139. https://doi.org/10.1016/j.athoracsur.2019.08.075

    Article  PubMed  Google Scholar 

  40. Wong J, Lam DP, Abrishami A, Chan MTV, Chung F (2012) Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth J Can Anesth 59(3):268–279. https://doi.org/10.1007/s12630-011-9652-x

    Article  Google Scholar 

  41. Hoch JS, Barr HK, Guggenbickler AM, Dewa CS (2022) Lessons from cost-effectiveness analysis of smoking cessation programs for cancer patients. Curr Oncol Tor Ont 29(10):6982–6991. https://doi.org/10.3390/curroncol29100549

    Article  Google Scholar 

  42. Levy DE, Regan S, Perez GK et al (2022) Cost-effectiveness of implementing smoking cessation interventions for patients with cancer. JAMA Netw Open 5(6):e2216362. https://doi.org/10.1001/jamanetworkopen.2022.16362

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jiménez-Ruiz CA, Martín V, Alsina-Restoy X et al (2020) Cost-benefit analysis of funding smoking cessation before surgery. Br J Surg 107(8):978–994. https://doi.org/10.1002/bjs.11506

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA

    Theresa N. Wang, Robert Tamer, Tarik K. Yuce, Roukaya T. Hassanein, Kelly R. Haisley, Kyle A. Perry & Patrick J. Sweigert

  2. College of Medicine, The Ohio State University, Columbus, OH, USA

    Bryan W. An & Tina X. Wang

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Theresa Wang, Bryan An, Tina Wang, Robert Tamer, Tarik Yuce, Roukaya Hassanein, Kelly Haisley, Kyle Perry and Patrick Sweigert have no conflicts of interest or financial ties to disclose.

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Meeting Presentation: SAGES 2023 – Montreal, Canada.

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Wang, T.N., An, B.W., Wang, T.X. et al. Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair. Surg Endosc 37, 7238–7246 (2023). https://doi.org/10.1007/s00464-023-10185-9

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