Journal Review in Hernia Surgery: Smoking in Elective Open Ventral Hernia Repair

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 28 September 2023

⏱️ 28 minutes

🔗️ Recording | iTunes | RSS

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Summary

How do you counsel the patient with a large painful hernia who still smokes a pack of cigarettes every day? Join Drs. Michael Rosen, Clayton Petro, Sara Maskal, and Ryan Ellis as they discuss some of the highlights in the literature on smoking and its impact on postoperative outcomes in elective, clean open ventral hernia repairs.

Hosts:
- Michael Rosen, Cleveland Clinic
- Clayton Petro, Cleveland Clinic
- Sara Maskal, Cleveland Clinic
- Ryan Ellis, Cleveland Clinic, @ryanellismd

Learning objectives:
- Evaluate historical data on smoking in surgery
- Compare with newer literature specific to contemporary ventral hernia repairs
- Understand how the historical and new data can be applied in clinical practice

References:
Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002 Jan 12;359(9301):114-7. doi: 10.1016/S0140-6736(02)07369-5. PMID: 11809253.

Kubasiak JC, Landin M, Schimpke S, Poirier J, Myers JA, Millikan KW, Luu MB. The effect of tobacco use on outcomes of laparoscopic and open ventral hernia repairs: a review of the NSQIP dataset. Surgical Endoscopy. 2017 Jun;31:2661-6.

DeLancey JO, Blay Jr E, Hewitt DB, Engelhardt K, Bilimoria KY, Holl JL, Odell DD, Yang AD, Stulberg JJ. The effect of smoking on 30-day outcomes in elective hernia repair. The American Journal of Surgery. 2018 Sep 1;216(3):471-4.

Sørensen LT. Wound healing and infection in surgery: the clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Archives of surgery. 2012 Apr 1;147(4):373-83.

Petro CC, Haskins IN, Tastaldi L, Tu C, Krpata DM, Rosen MJ, Prabhu AS. Does active smoking really matter before ventral hernia repair? An AHSQC analysis. Surgery. 2019 Feb;165(2):406-411. doi: 10.1016/j.surg.2018.07.039. Epub 2018 Sep 13. PMID: 30220485.

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Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:22.0	Welcome to Behind the Night, I'm Sarah Maskell, a general surgery resident at the Democratic
0:25.8	Representing one of this hernia subspecialty teams.
0:28.8	I'm Ryan Ellis, also general surgery resident.
0:30.8	We're here with Dr. Michael Rosen, the director of the Center for Abdomacor Health at the Cleveland Clinic,
0:35.8	and has partnered Dr. Clayton Petro.
0:37.8	Both are leaders in the field of hernia and have contributed to the field through numerous clinical trials and have authored multiple textbooks.
0:43.8	Thanks for having me, I really appreciate the opportunity to talk about this.
0:46.8	This is a huge passion of mine.
0:48.8	Hey guys, this is Mike Rosen, excited to be here.
0:51.8	Our topic today is hernia repairs and smokers.
0:54.8	In case anyone out there didn't already know, smoking is bad for your health.
0:57.8	There is a myriad of detrimental effects of smoking, including cardiovascular disease, pulmonary disease, increased cancer risk,
1:04.8	and there's no shortage of literature at wood and game, pre-operative smoking with post-operative morbidity.
1:10.8	The reason we're revisiting this topic in hernia surgery specifically is because pre-operative optimization has become a buzzword in this field.
1:18.8	Smoking is a common reason to postpone elective hernia repair.
1:22.8	We want to review the current literature to evaluate if we're disingenuously withholding care, often to underprivilege.
1:29.8	In this quip data, for multiple surgical subspecialties, has supported this association between smoking and morbidity,
1:35.8	and RCTs have demonstrated that pre-operative smoking cessation, at least four weeks before an operation, can decrease this risk.
1:41.8	That approximately 15% of the American population continues to smoke.
1:45.8	There's also data to suggest that active smokers are at a higher risk for developing incisional hernias after primary lap rotamies,
1:52.8	with respect to open ventral hernia repair is over 380,000 are performed annually in the United States.
	...

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