Wound Healing/Plastic SurgerySmoking and wound complications after coronary artery bypass grafting
Introduction
Arterial conduits are widely preferred for coronary revascularization; however, great saphenous veins are still commonly used in most coronary artery bypass graft (CABG) surgeries [1]. Despite improvements in surgical techniques and perioperative care, leg and sternal wound healing disturbances remain significant causes of postoperative morbidity, impaired quality of life, and increased inhospital stay among patients undergoing CABG. The rates of sternal and leg wound healing complications after CABG surgery range from 0.5%–10% and 1%–44%, respectively [2], [3], [4], [5], [6], [7], [8]. Female gender, diabetes mellitus, obesity, and peripheral vasculopathies have been identified as significant independent predictors of post-CABG wound complications [9], [10], [11]. Also, smoking has been shown to be associated with wound healing complications after several types of surgeries [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]; however, the potential role of smoking as an independent contributor to the post-CABG wound healing disturbances has been less explored.
In this study, we aimed to compare the incidence of leg and sternal wound complications in two groups of post-CABG smoker and nonsmoker patients.
Section snippets
Study design and population
A total of 810 patients including 405 smokers and 405 nonsmokers who had undergone an elective CABG surgery were enrolled consecutively between June 2007 and August 2013. The patients were excluded if (1) they were found to be immunocompromised or on steroids within the 3 mo before surgery, (2) they were unable to complete follow-up, and (3) the procedure involved the use of only arteries as conduits for myocardial revascularization. The demographic characteristics of patients and data
Results
No patients were lost to follow-up, and all the patients were evaluated in terms of postoperative leg and sternal wound complications within the first 7 d as well as at 6-wk postsurgical visit.
The univariate comparison of demographic and preoperative clinical characteristics between smokers and nonsmokers is listed in Table 1. There was no significant difference between groups with respect to demographics and known risk factors of wound complications. The prevalence of COPD, however, was
Discussion
To the best of our knowledge, this is one of the largest prospective studies to date evaluating the association of smoking with the incidence of both leg and sternal wound complications in post-CABG patients. In this study, the overall rate of wound complications was 19.2% for leg and 4.6% for sternal incisions in post-CABG patients. The reported rates of wound complications after CABG are inconsistent among different studies [2], [3], [4], [5], [6], [7], [8]. This interstudy variability could
Conclusions
In this study, we demonstrated that smoking is an independent predictor of wound dehiscence and skin necrosis after CABG surgeries. Further studies are needed to confirm the findings of the present study, to address the drawbacks of previous studies and to assess the applicability of these results in daily medical practice.
Acknowledgment
Authors' contributions: P.S. and B.S.-K. contributed to the conception of the study. P.S., B.S.-K., and M.-H.M. did the design of the work. P.S., M.-H.M., L.S., N.B., G.H., and H.S. did the acquisition of the study. P.S. did the analysis and interpretation of data for the work, literature search, and drafting the work. B.S.-K. did the revising and approving the final version of the article for submission. M.-H.M. contributed to the provision of materials, patients, and resources. L.S., N.B.,
References (41)
- et al.
Leg wound infection after coronary bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting
Ann Thorac Surg
(2003) - et al.
Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery
Am J Surg
(2002) - et al.
Saphenous vein harvest with SaphLITE system versus conventional technique: a prospective, randomized study
Ann Thorac Surg
(2005) - et al.
Novel treatment strategy for leg and sternal wound complications after coronary artery bypass graft surgery: bioengineered Apligraf
Ann Thorac Surg
(2004) - et al.
Is it justified to refuse breast reduction to smokers?
J Plast Reconstr Aesthet Surg
(2007) - et al.
Smoking as a risk factor for wound healing and infection in breast cancer surgery
Eur J Surg Oncol
(2002) - et al.
Major leg wound complications after saphenous vein harvest for coronary revascularization
Ann Thorac Surg
(2000) - et al.
Wound-healing disturbances after vein harvesting for CABG: a randomized trial to compare the minimally invasive direct vision and traditional approaches
Ann Thorac Surg
(2001) - et al.
Effect of smoking, smoking cessation, and nicotine patch on wound dimension, vitamin C, and systemic markers of collagen metabolism
Surgery
(2010) - et al.
Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis
J Surg Res
(2009)
Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery
J Cardiol
eComment: leg wound morbidities after saphenous vein harvesting techniques. Which is better?
Interact Cardiovasc Thorac Surg
Minimally invasive saphenous vein harvesting guided by preoperative echotomography: results of a prospective randomized study
Interact Cardiovasc Thorac Surg
Topical application of autologous blood products during surgical closure following a coronary artery bypass graft
Eur J Cardiothorac Surg
Prevalence of 90-days postoperative wound infections after cardiac surgery
Eur J Cardiothorac Surg
Risk factors for leg wound complications following endoscopic vs. traditional saphenous vein harvesting
Heart Surg Forum
The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery
Tohoku J Exp Med
Depression, healing, and recovery from coronary artery bypass surgery
Am J Crit Care
The effect of cigarette smoking on wound healing
Scand J Plast Reconstr Surg Hand Surg
Smoking is a risk factor for incisional hernia
Arch Surg
Cited by (16)
Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature
2022, Heart and LungCitation Excerpt :The interaction between these factors are complex and multifaceted. For instance the impact of smoking is recorded in a number of studies,29,49 with rates of dehiscence 3.5 folds higher in those who consumed >20 cigarettes per day than in those who smoked <20 cigarettes per day.49 The relationship between smoking and COPD is well established,50 so it is perhaps of no surprise that both are identified as risk factors.
Risk factors associated with longer stays in cardiovascular surgical intensive care unit after CABG
2022, Journal of the Formosan Medical AssociationCitation Excerpt :Data for the process factors included 3-day averaged laboratory values for organic function, including creatinine kinase (CK), creatinine kinase MB (CK-MB), ratio of arterial oxygen partial pressure to inspired oxygen fraction (PaO2/FiO2 ratio), total bilirubin, creatinine, white blood cell (WBC) count and body temperature via Swan–Ganz catheter. Those represent risk of infection, organic function and comorbidity of CABG followed with the US Centers for Disease Control and Prevention guidelines (Fig. 2).1,5–8,13,14,17,30,31 All data were analyzed using SPSS 22.0 software (SPSS Inc, Chicago, IL, USA).
The Impact of Smoking on Early Postoperative Complications in Hand Surgery
2021, Journal of Hand SurgerySmoking cessation: Adherence based on patients’ illness perception after coronary artery bypass grafting surgery
2018, Indian Heart JournalCitation Excerpt :Smoking can increase the rate of myocardial infarction several folds in patients with cardiovascular diseases.7 Many studies showed that smoking after CABG could increase the risk of CAD recurrence, potentially leading to pulmonary complications, myocardial infarction, the disturbances of wound healing, hospital readmission, and even death.8–10 Many of studies showed that smoking might predict serious post-operative complications after CABG.11,12
Impact of smoking on the outcomes of minimally invasive direct coronary artery bypass
2023, Journal of Cardiothoracic Surgery
- 1
Equal first authors.