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Impact of electronic cigarette (E-cigarette) vaping on postoperative wound healing and surgical site infections following mastectomy
Kerivan, Lauren T.
Kerivan, Lauren T.
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Abstract
Background
Cigarette smoking has been established as an independent risk factor for postoperative wound complications after breast cancer surgery. As electronic (E)-cigarettes gain popularity as “cleaner” alternatives to conventional cigarettes, there is a critical need for evidence demonstrating the risk profile for perioperative vape usage. Thus, the aim of this study was to delineate the impact of E-cigarette vaping on postoperative surgical site complications after prophylactic or therapeutic mastectomy.
Methods
Using the Healthcare Enterprise Repository for Ontological Narration (HERON) data repository at the University of Kansas Medical Center (KUMC), a retrospective cohort of adult (≥18 years) women who underwent therapeutic or prophylactic mastectomy at KUMC from January 2020 to January 2024 was generated. Patients with current E-cigarette use, identified by self-reported active vaping within the 12 months preceding surgery, were matched with non-vaping patients in a 1:3 ratio using a greedy, nearest-neighbor propensity score matching algorithm. The primary outcome was a composite of 30-day postoperative wound complications consisting of surgical site infection (SSI), wound dehiscence, tissue necrosis and hematoma formation. Secondary outcomes included the individual components of the composite primary outcome. Covariates included patient race, ethnicity, age, body mass index (BMI), diabetes mellitus (drug-related or diet-related), long-term use of systemic steroids, and current smoking status.
Results
A total of 1,109 women who underwent mastectomy were included, comprising 39 vapers and 1070 non-vapers. After 1:3 propensity score matching, 33 vapers were matched to 99 non-vapers. In the matched cohort, conditional univariable logistic regression demonstrated a significant positive association between perioperative vaping and the primary composite outcome, such that the odds of any postoperative cutaneous complication were significantly increased in active vapers as compared to non-vapers (OR, 4.57; 95% CI, 1.48-14.13; P = 0.008). Perioperative vaping was associated with a significantly increased odds of SSI (OR, 6.60; 95% CI, 1.84-23.61; P = 0.004) and wound necrosis events (OR, 6.96; 95% CI, 0.32-40.18; P = 0.03). No difference was found between the matched cohorts in the odds of dehiscence (OR 2.87; 95% CI, 0.64-12.83; P=0.169). Due to low incidence, hematoma formation (2.9% and 0% in vapers and non-vapers, respectively), was not included in the outcome analysis.
Conclusion
To our knowledge, this is the first cohort study to investigate the impact of perioperative vaping on surgical site complications and to demonstrate an increased risk of SSI and wound necrosis in vapers who undergo mastectomy. While there are clear evidence-based guidelines for the management of preoperative smoking, heretofore, there has been no data from clinical trials or guidance from major professional organizations to support clinical decision-making related to vaping cessation in the surgical patient. Additional studies are still needed to determine the impact of E-cigarette vaping on postoperative outcomes and should be performed in a variety of surgical settings to determine the generalizability of our results.
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Date
2024-01-01
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University of Kansas
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This item contains archived web content.
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Kerivan_ku_0099M_19621.pdf
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- Embargoed until 2174-05-31
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Keywords
Surgery, E-Cigarette, Mastectomy, Postoperative complications, Propensity Score, Surgical site infection, Vaping