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

## TL;DR

This study found that active smoking does not significantly increase long-term complications after abdominal wall surgery, suggesting that surgery can be considered for smokers who are otherwise suitable candidates.

## Contribution

The study provides new evidence on the long-term impact of active smoking on hernia recurrence and surgical complications after abdominal wall reconstruction.

## Key findings

- Active smokers had similar rates of wound complications and hernia recurrence as never-smokers at 24 months.
- Smoking was not associated with increased mesh-related complications or reoperation rates in the long term.
- The results support a patient-centered approach where smoking cessation is encouraged but not required before surgery.

## Abstract

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.

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.

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).

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.