New Study: Smoking Doesn't Up Skin Surgery Risk

LAS VEGAS — The incidence of complications following skin surgery is no different in smokers, compared with nonsmokers, results from a 5-year, single-center study demonstrated.

The finding flies in the face of conventional thinking that smokers "do worse after skin surgery, that they heal slower, and that they get more infections," Dr. Anthony Dixon said at the annual meeting of the International Society for Dermatologic Surgery.

A study from 1992 suggested that smoking compromises wound repair in part because nicotine reduces blood flow to the skin and increases blood platelet aggregation, which raises the risk of microthrombosis (Am. J. Med. 1992;93:22S-4S). The author also said that carbon monoxide decreases oxygen transport and metabolism.

"But unfortunately, until now there hasn't been a long prospective trial to find out whether or not this theory is true," said Dr. Dixon of the dermatology department at Australia's Bond University in Robina, Queensland. "Many dermatologists advise patients to cease smoking for a week prior to having skin surgery. There's no evidence base for that."

He and his associates conducted an observational study of 7,224 lesions excised on 4,197 patients between July 2002 and July 2007. Dr. Dixon performed all procedures; the average patient age was 65 years, and 55% were male.

In all, there were 286 complications (3.96%). The most common complication was infection, followed by bleeding, dehiscence, and skin necrosis.

Dr. Dixon reported that the incidence of total complications was similar between smokers and nonsmokers (3.6% vs. 4.0%, respectively). The incidence of infection was 1.9% in smokers, compared with 2.2% in nonsmokers, a difference that was not statistically significant. Bleeding occurred in 0.2% of smokers and in 0.8% of nonsmokers, a difference that was also not statistically significant.

Logistic regression analysis that adjusted for age, sex, operation type, lesion diagnosis, body site location, and socioeconomic background found that smoking did not predict any complication.

Based on these findings, "we can't justify smoking cessation prior to skin surgery," said Dr. Dixon, who emphasized that he and his fellow researchers "are all nonsmokers and we encourage our patients not to smoke for other health reasons. There are certainly things we try to get our patients to remember prior to surgery, but stopping smoking is not one of them."

In an interview, he acknowledged certain limitations of the study, including the fact that some of the patients may have been smokers but did not declare themselves as such. "Also, Australia has one of the lowest rates of smoking in the Western world and this may not reflect circumstances in countries with much higher smoking rates," he said.

In a separate analysis to be published in Dermatologic Surgery, he and his associates studied the same patient population to investigate the incidence of complications after skin surgery in diabetic and nondiabetic patients. Of the 4,197 patients in the study, 196 had known diabetes and 4,001 did not. The average age of diabetic patients was 72 years.

The incidence of total complications between diabetic and nondiabetic patients was the same, at 1.8%, but the incidence of infection was significantly higher in patients with diabetes (4.2%), compared with those without (2.0%). Bleeding occurred in 0.9% of diabetic patients and 0.7% of nondiabetic patients, a difference that was not statistically significant.

Logistic regression analysis that adjusted for age, sex, operation type, lesion diagnosis, body site location, and socioeconomic background found that a known history of diabetes was predictive of infection.

Dr. Dixon, who is also director of research for a group of skin cancer clinics in Australia, had no disclosures to make.

Patients are advised to cease smoking 1 week before skin surgery. 'There's no evidence base for that.' DR. DIXON

LAS VEGAS — The incidence of complications following skin surgery is no different in smokers, compared with nonsmokers, results from a 5-year, single-center study demonstrated.

The finding flies in the face of conventional thinking that smokers "do worse after skin surgery, that they heal slower, and that they get more infections," Dr. Anthony Dixon said at the annual meeting of the International Society for Dermatologic Surgery.

A study from 1992 suggested that smoking compromises wound repair in part because nicotine reduces blood flow to the skin and increases blood platelet aggregation, which raises the risk of microthrombosis (Am. J. Med. 1992;93:22S-4S). The author also said that carbon monoxide decreases oxygen transport and metabolism.

"But unfortunately, until now there hasn't been a long prospective trial to find out whether or not this theory is true," said Dr. Dixon of the dermatology department at Australia's Bond University in Robina, Queensland. "Many dermatologists advise patients to cease smoking for a week prior to having skin surgery. There's no evidence base for that."

He and his associates conducted an observational study of 7,224 lesions excised on 4,197 patients between July 2002 and July 2007. Dr. Dixon performed all procedures; the average patient age was 65 years, and 55% were male.

In all, there were 286 complications (3.96%). The most common complication was infection, followed by bleeding, dehiscence, and skin necrosis.

Dr. Dixon reported that the incidence of total complications was similar between smokers and nonsmokers (3.6% vs. 4.0%, respectively). The incidence of infection was 1.9% in smokers, compared with 2.2% in nonsmokers, a difference that was not statistically significant. Bleeding occurred in 0.2% of smokers and in 0.8% of nonsmokers, a difference that was also not statistically significant.

Logistic regression analysis that adjusted for age, sex, operation type, lesion diagnosis, body site location, and socioeconomic background found that smoking did not predict any complication.

Based on these findings, "we can't justify smoking cessation prior to skin surgery," said Dr. Dixon, who emphasized that he and his fellow researchers "are all nonsmokers and we encourage our patients not to smoke for other health reasons. There are certainly things we try to get our patients to remember prior to surgery, but stopping smoking is not one of them."

In an interview, he acknowledged certain limitations of the study, including the fact that some of the patients may have been smokers but did not declare themselves as such. "Also, Australia has one of the lowest rates of smoking in the Western world and this may not reflect circumstances in countries with much higher smoking rates," he said.

In a separate analysis to be published in Dermatologic Surgery, he and his associates studied the same patient population to investigate the incidence of complications after skin surgery in diabetic and nondiabetic patients. Of the 4,197 patients in the study, 196 had known diabetes and 4,001 did not. The average age of diabetic patients was 72 years.

The incidence of total complications between diabetic and nondiabetic patients was the same, at 1.8%, but the incidence of infection was significantly higher in patients with diabetes (4.2%), compared with those without (2.0%). Bleeding occurred in 0.9% of diabetic patients and 0.7% of nondiabetic patients, a difference that was not statistically significant.

Logistic regression analysis that adjusted for age, sex, operation type, lesion diagnosis, body site location, and socioeconomic background found that a known history of diabetes was predictive of infection.

Dr. Dixon, who is also director of research for a group of skin cancer clinics in Australia, had no disclosures to make.

Patients are advised to cease smoking 1 week before skin surgery. 'There's no evidence base for that.' DR. DIXON

LAS VEGAS — The incidence of complications following skin surgery is no different in smokers, compared with nonsmokers, results from a 5-year, single-center study demonstrated.

The finding flies in the face of conventional thinking that smokers "do worse after skin surgery, that they heal slower, and that they get more infections," Dr. Anthony Dixon said at the annual meeting of the International Society for Dermatologic Surgery.

A study from 1992 suggested that smoking compromises wound repair in part because nicotine reduces blood flow to the skin and increases blood platelet aggregation, which raises the risk of microthrombosis (Am. J. Med. 1992;93:22S-4S). The author also said that carbon monoxide decreases oxygen transport and metabolism.

"But unfortunately, until now there hasn't been a long prospective trial to find out whether or not this theory is true," said Dr. Dixon of the dermatology department at Australia's Bond University in Robina, Queensland. "Many dermatologists advise patients to cease smoking for a week prior to having skin surgery. There's no evidence base for that."

He and his associates conducted an observational study of 7,224 lesions excised on 4,197 patients between July 2002 and July 2007. Dr. Dixon performed all procedures; the average patient age was 65 years, and 55% were male.

In all, there were 286 complications (3.96%). The most common complication was infection, followed by bleeding, dehiscence, and skin necrosis.

Dr. Dixon reported that the incidence of total complications was similar between smokers and nonsmokers (3.6% vs. 4.0%, respectively). The incidence of infection was 1.9% in smokers, compared with 2.2% in nonsmokers, a difference that was not statistically significant. Bleeding occurred in 0.2% of smokers and in 0.8% of nonsmokers, a difference that was also not statistically significant.

Logistic regression analysis that adjusted for age, sex, operation type, lesion diagnosis, body site location, and socioeconomic background found that smoking did not predict any complication.

Based on these findings, "we can't justify smoking cessation prior to skin surgery," said Dr. Dixon, who emphasized that he and his fellow researchers "are all nonsmokers and we encourage our patients not to smoke for other health reasons. There are certainly things we try to get our patients to remember prior to surgery, but stopping smoking is not one of them."

In an interview, he acknowledged certain limitations of the study, including the fact that some of the patients may have been smokers but did not declare themselves as such. "Also, Australia has one of the lowest rates of smoking in the Western world and this may not reflect circumstances in countries with much higher smoking rates," he said.

In a separate analysis to be published in Dermatologic Surgery, he and his associates studied the same patient population to investigate the incidence of complications after skin surgery in diabetic and nondiabetic patients. Of the 4,197 patients in the study, 196 had known diabetes and 4,001 did not. The average age of diabetic patients was 72 years.

The incidence of total complications between diabetic and nondiabetic patients was the same, at 1.8%, but the incidence of infection was significantly higher in patients with diabetes (4.2%), compared with those without (2.0%). Bleeding occurred in 0.9% of diabetic patients and 0.7% of nondiabetic patients, a difference that was not statistically significant.

Logistic regression analysis that adjusted for age, sex, operation type, lesion diagnosis, body site location, and socioeconomic background found that a known history of diabetes was predictive of infection.

Dr. Dixon, who is also director of research for a group of skin cancer clinics in Australia, had no disclosures to make.

Patients are advised to cease smoking 1 week before skin surgery. 'There's no evidence base for that.' DR. DIXON