title: Smoking as a risk factor for wound healing and infection in breast cancer surgery.
abstract: OBJECTIVE
  Clinical studies suggest that smoking is associated with wound necrosis after breast cancer surgery. However, the significance of smoking as a risk factor for wound infection, skin flap necrosis, and epidermolysis when adjusting for other potential risk factors remains to be studied.
  
  
  METHODS
  From June 1994 through August 1996, 425 patients underwent breast cancer surgery as simple mastectomy, modified radical mastectomy, or breast conserving surgery. The patients were evaluated postoperatively for wound infection, skin flap necrosis, and epidermolysis. Association between these complications and 17 patient, operative, and postoperative variables were analysed by three separate multiple logistic regression analyses.
  
  
  RESULTS
  When compared to non-smoking, smoking was significantly associated with wound infection after all types of surgery (light smoking (1-14 grams per day): [odds ratio (OR)=2.95, 95% confidence interval (95% CI)=1.07-8.16], and heavy smoking (>/=15 grams per day): OR=3.46 (1.52-7.85). A similar significant association was found as regards skin flap necrosis and epidermolysis after simple mastectomy and modified radical mastectomy: both light and heavy smoking were predictive for skin flap necrosis: light smoking: OR=6.85 (1.96-23.90), heavy smoking: OR=9.22 (2.91-29.25) and for epidermolysis: light smoking: OR=3.98 (1.52-10.43) and heavy smoking: OR=4.28 (1.81-10.13). No significant dose-response relation was disclosed. Other risk factors and confounders associated with complicated wound healing were adjusted for in the analysis: diabetes, obesity, alcohol, NSAIDs, duration of surgery, and surgical experience.
  
  
  CONCLUSIONS
  Independent of other risk factors, smoking is predictive for post-mastectomy wound infection, skin flap necrosis, and epidermolysis.
authors.affiliation: Department of Surgical Gastroenterology K, Bispebjerg University Hospital, Copenhagen Hospital Corporation, Denmark. lts@dadlnet.dk
authors.forename: L T
authors.initials: LT
authors.lastname: Sørensen
authors.forename: J
authors.initials: J
authors.lastname: Hørby
authors.forename: E
authors.initials: E
authors.lastname: Friis
authors.forename: B
authors.initials: B
authors.lastname: Pilsgaard
authors.forename: T
authors.initials: T
authors.lastname: Jørgensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009336:Necrosis; D016017:Odds Ratio; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology*; D014945:Wound Healing