Plastic surgery and smoking:  a prospective analysis of incidence, compliance, and complications.
BACKGROUND
Tobacco use remains a persistent risk factor in elective plastic surgery. Although nicotine is thought to increase complications, which procedures are affected and the reliability of patient-provided histories remain poorly defined. The authors sought to examine nicotine use and its impact on outcomes.


METHODS
All patients in a single-surgeon practice undergoing surgery with general anesthesia during a 2-year period were enrolled. Preoperative evaluation included a thorough smoking history. All patients had urine samples taken on the day of surgery to assess for nicotine metabolites. Patients were followed for a minimum of 3 months after surgery and monitored for complications.


RESULTS
Four hundred fifteen patients were enrolled. Of these, 139 (33.5 percent) stated that they had quit smoking and 39 (9.4 percent) were admitted active smokers. For the 362 patients with urine nicotine analysis available, 54 showed active smoking. Fifteen of these (4.1 percent) had denied current tobacco use. Patients stating that they had quit smoking were more likely to be deceitful than those stating they had never smoked (p < 0.001). Smokers had significantly higher overall complication rates (OR, 3.7; p < 0.001) and tissue necrosis rates (OR, 4.3; p = 0.02) and were likelier to require reoperation (OR, 3.7; p < 0.001).


CONCLUSIONS
In a large cohort study examining the prevalence and impact of nicotine in the general plastic surgery population, substantial rates of deception regarding smoking status were found. Furthermore, active smoking was strongly correlated with complications. A methodologic approach to the detection and management of patients using tobacco products can help to optimize outcomes.


METHODS
Risk, II.
Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Medical Institutions.
Devin
D
Coon
Sami
S
Tuffaha
Joani
J
Christensen
Steven C
SC
Bonawitz
D000328:Adult; D006801:Humans; D015994:Incidence; D009538:Nicotine / Q000652:urine; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000652:urine; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012907:Smoking / Q000009:adverse effects* / Q000652:urine; D016540:Smoking Cessation
D009538:Nicotine