Conflicts of interest None declared.
Prospective study of skin surgery in smokers vs. nonsmokers
Article first published online: 25 SEP 2008
© 2008 The Authors. Journal Compilation © 2008 British Association of Dermatologists
British Journal of Dermatology
Volume 160, Issue 2, pages 365–367, February 2009
How to Cite
Dixon, A.J., Dixon, M.P., Dixon, J.B. and Del Mar, C.B. (2009), Prospective study of skin surgery in smokers vs. nonsmokers. British Journal of Dermatology, 160: 365–367. doi: 10.1111/j.1365-2133.2008.08846.x
- Issue published online: 16 JAN 2009
- Article first published online: 25 SEP 2008
- Accepted for publication 14 July 2008
Background Smoking may increase complications following minor surgery leading many clinicians to urge patients to refrain from smoking before and after surgery.
Objective To study the association between smoking and complications following skin surgery.
Methods In a 5-year prospective observational study 7224 lesions were excised on 4197 patients. Patients were not instructed regarding smoking. All complications were recorded.
Results A total of 439 smokers (10·5%) underwent 646 procedures (9%), 3758 nonsmokers (89·5%) underwent 6578 procedures (91%). Smokers were younger (55 ± 16 years) than nonsmokers (66 ± 17 years) (P < 0·001). Infection incidence was not significantly different, 1·9% (12/646) in smokers compared with 2·2% (146/6578) in nonsmokers (P = 0·55). There were two bleeds with smokers (0·3%) vs. 50 in nonsmokers (0·8%) (P = 0·2). The incidence of wound dehiscence in nonsmokers (three) was not different from nonsmokers (21) (P = 0·54). However, the incidence of scar contour distortion in smokers (three) was greater than in nonsmokers (two) (odds ratio 15·3; 95% confidence interval 2·5–92). Total complication incidence was similar, 3·6% in smokers vs. 4·0% in nonsmokers (P = 0·58). Out of 2371 flaps there were 14 (0·6%) cases of end-flap necrosis but smokers were not at increased risk. The case–control analysis compared each smoker with two nonsmokers matched for age, sex, postal code and outdoor occupational exposure. This again demonstrated no difference in infection, scar complication, bleed, dehiscence, end-flap necrosis or total complication incidence.
Conclusions Smokers and nonsmokers suffer skin surgery complications similarly. The increased risk of contour distortion identified was difficult to interpret. Advice to cease smoking in the short term to improve outcomes with skin cancer surgery is not supported by these data.