title: Recent smoking is a risk factor for anal abscess and fistula.
abstract: BACKGROUND
  Smoking is a risk factor for inflammatory, fistulizing cutaneous diseases. It seems reasonable that smoking might be a risk factor for anal abscess/fistula.
  
  
  OBJECTIVE
  This study aimed to test the hypothesis that recent smoking is a risk factor for development of anal abscess/fistula.
  
  
  METHODS
  This is a case-control study.
  
  
  METHODS
  This study was conducted at a Department of Veterans Affairs general surgical clinic.
  
  
  METHODS
  Included in the study were 931 patients visiting the general surgical clinic over a 6-month period.
  
  
  METHODS
  A tobacco use questionnaire was administered.
  
  
  METHODS
  Patients with anal abscess/fistula history were compared with controls, who had all other general surgical conditions. To investigate the temporal relation between smoking and the clinical onset of anal abscess/fistula, we compared the group consisting of current smokers and former smokers who had recently quit, against the group consisting of nonsmokers and former smokers who had quit a longer time ago (ie, not recently). We excluded patients with IBD and HIV.
  
  
  RESULTS
  Cases and controls were comparable in age (57 and 59 y) and sex (93% and 97% male). After exclusions, there were 74 anal abscess/fistula cases and 816 controls. Among the anal abscess/fistula cases, 36 patients had smoked within 1 year before the onset of anal abscess/fistula symptoms, and 38 had not smoked within the prior year; among controls, 249 had smoked within 1 year before seeking surgical treatment, and 567 had not (OR 2.15, 95% CI 1.34-3.48, 2-tail P = .0025). Using a 5-year cutoff for recent smoking, the association was less pronounced but still significant (OR 1.72, 95% CI 1.03-2.86, P = .0375), and the association was insignificant at 10 years (OR 1.34, 95% CI 0.78-2.21, P = .313).
  
  
  CONCLUSIONS
  Limitations of the study included self-selection bias, recall bias, convenience sample, and noninvestigation of the dose-response relationship.
  
  
  CONCLUSIONS
  Recent smoking is a risk factor for anal abscess/fistula development. As in other smoking-related diseases, the influence of smoking as a risk factor for anal abscess/fistula diminishes to baseline after 5 to 10 years of smoking cessation. Anal abscess/fistula can be added to the list of chronic, inflammatory cutaneous conditions associated with smoking.
authors.affiliation: 1Halasz General Surgery Section, Surgical Service, VA San Diego Healthcare System, San Diego, California 92161-0002, USA.
authors.forename: Bikash
authors.initials: B
authors.lastname: Devaraj
authors.forename: Soheil
authors.initials: S
authors.lastname: Khabassi
authors.forename: Bard C
authors.initials: BC
authors.lastname: Cosman
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D015984:Causality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans