New research on smoking complication risks

According to recent research, smokers are more likely than nonsmokers to have complications after undergoing cosmetic surgery on the body, versus the face or breasts.

Smokers are more likely than nonsmokers to have complications after undergoing cosmetic surgery on the body, versus the face or breasts. In addition, smoking is an independent risk factor for major surgical site infections, according to an analysis of 129,007 cosmetic surgery patients published January 2019 in the Aesthetic Surgery Journal

“Given the growing number of women and men seeking aesthetic surgery, more and more providers will offer their services to smokers. The findings of our study will further assist surgeons in anticipating the extent of morbidity that may be seen in smokers following cosmetic surgery, and how those risks vary depending on the operative procedure,” study primary author Christodoulos Kaoutzanis, M.D., reports.

Many surgical disciplines have documented that smoking is linked with postoperative adverse outcomes, but such studies are scarce for aesthetic surgical procedures. About 15.5% of U.S. adults smoke, according to CDC statistics.

Dr. Kaoutzanis and colleagues from the Department of Plastic Surgery at Vanderbilt University Medical Center analyzed data from the CosmetAssure insurance program, which covers costs for unexpected major complications from 24 cosmetic surgical procedures.

“In this analysis, only 8.2% of patients undergoing surgery reported smoking, which is lower than the national average, and may reflect the concerns of well-trained plastic surgeons in regard to smoking and complications in the perioperative period that led to very careful selection of the appropriate candidates,” according to the study’s senior author Kye Higdon, M.D.

Researchers prospectively evaluated smoking as a risk factor for major complications. Although the analysis showed very comparable overall major complication rates between smokers and nonsmokers undergoing aesthetic surgery, smoking was found to be an independent risk factor for major surgical site infections on multivariate analysis. In addition, smokers having body procedures, such as abdominoplasty and buttock augmentation, had a major complication rate of 2.9%, versus 1.9% for nonsmokers. Notably, complications stood out after thigh lifts, at 23.8% for smokers versus 3.6% for nonsmokers, as well as male breast surgery, in which major complications occurred in 3.7% of smokers compared to 1.4% of nonsmokers.

Smoking, they found, increased the risk of wound infections by 61%.

There were no notable differences in complication rates between smokers and nonsmokers having facial or breast cosmetic procedures.
These findings, according to Dr. Kaoutzanis, not only enhance preoperative education, but also improve operative planning and overall patient safety.

“It will also allow patients to make better-informed decisions and set realistic expectations regarding postoperative results,” he reports. “Awareness of these high-risk groups will make providers more vigilant in the postoperative period.”

Given the results, surgeons should consider avoiding combined body procedures with breast or face procedures in smokers, he writes.

“Additional studies are needed to provide more thorough recommendations and establish patient care protocols on the duration of smoking cessation in the perioperative period to further optimize outcomes,” the authors write.


Study author James C. Grotting, MD, is a founder and shareholder of CosmetAssure.