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The impact of smoking on inguinal hernia repair outcomes: a meta-analysis of multivariable-adjusted studies

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Abstract

Purpose

While the detrimental effects of smoking on postoperative outcomes are recognized, the extent of its risk for inguinal hernia repair remains unclear. Our study aims to assess the influence of smoking on patients who undergo inguinal hernia repair.

Methods

We systematically reviewed PubMed, Embase, and Cochrane databases. Our goal was to identify studies that compared postoperative outcomes in smoking and non-smoking patients after inguinal hernia repair, and which employed a multivariate analysis to reduce possible confounding factors. Outcomes were recurrence, postoperative complications, and surgical site infection. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed with the use of a random-effects model. Heterogeneity was examined with I2 statistics. This review was prospectively registered in PROSPERO (CRD42023445513).

Results

Our analysis encompassed 11 studies, involving a total of 577,901 patients. Of these, 77,226 (or 13.4%) identified as smokers, with males constituting 90% of the cohort. In terms of surgical approaches, 58% underwent laparoscopic procedures were most common at 58%, followed by open surgeries at 41%, and 1% used robotic techniques. All included studies had a low risk of bias. Smoking was associated with a higher incidence of hernia recurrence (OR 2.95; 95% CI 2.08 to 4.18; p < 0.001; I2 = 0%). No differences were found in postoperative complication (OR 1.15; 95% CI 1.00 to 1.32; p = 0.05; I2 = 56%) or surgical site infection (OR 2.94; 95% CI 0.80 to 10.88; p = 0.11; I2 = 79%).

Conclusion

Smoking was associated with a three-fold increase in recurrence. Further studies are needed to evaluate the impact of preoperative smoking cessation on reducing recurrence.

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Data availability

All data are available in the original studies included in this meta-analysis.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Division of Surgery, Federal University of the Southern Border (Universidade Federal da Fronteira Sul), 20 Capitão Araujo St, Passo Fundo, 99010-121, Brazil

    P. Marcolin

  2. Division of Surgery, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil

    B. Oliveira Trindade, S. Bueno Motter & G. R. Brandão

  3. Division of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    N. Messer & S. Mazzola Poli de Figueiredo

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  1. P. Marcolin
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  3. S. Bueno Motter
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  4. G. R. Brandão
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  5. N. Messer
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Contributions

SMPF and PM conceptualized the study. PM and BOT conducted the literature search and performed data analysis. PM drafted the manuscript, while SMPF, NM, BOT, GRB, and SBM provided critical revisions to the article.

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Correspondence to P. Marcolin.

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PM, SMPF, NM, BOT, GRB, and SBM declare no conflicts of interest.

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Marcolin, P., Oliveira Trindade, B., Bueno Motter, S. et al. The impact of smoking on inguinal hernia repair outcomes: a meta-analysis of multivariable-adjusted studies. Hernia (2024). https://doi.org/10.1007/s10029-024-03049-1

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