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Abstract
Aim: Clinical studies suggest that smoking is associated with wound necrosis after breast
cancer surgery. However, the significance of smoking as a risk factor for wound infection,
skin flap necrosis, and epidermolysis when adjusting for other potential risk factors
remains to be studied.
Methods: From June 1994 through August 1996, 425 patients underwent breast cancer surgery
as simple mastectomy, modified radical mastectomy, or breast conserving surgery. The
patients were evaluated postoperatively for wound infection, skin flap necrosis, and
epidermolysis. Association between these complications and 17 patient, operative,
and postoperative variables were analysed by three separate multiple logistic regression
analyses.
Results: When compared to non-smoking, smoking was significantly associated with wound infection
after all types of surgery (light smoking (1–14 grams per day): [odds ratio (OR)=2.95,
95% confidence interval (95% CI)=1.07–8.16], and heavy smoking (≥15 grams per day):
OR=3.46 (1.52–7.85). A similar significant association was found as regards skin flap
necrosis and epidermolysis after simple mastectomy and modified radical mastectomy:
both light and heavy smoking were predictive for skin flap necrosis: light smoking:
OR=6.85 (1.96–23.90), heavy smoking: OR=9.22 (2.91–29.25) and for epidermolysis: light
smoking: OR=3.98 (1.52–10.43) and heavy smoking: OR=4.28 (1.81–10.13). No significant
dose-response relation was disclosed. Other risk factors and confounders associated
with complicated wound healing were adjusted for in the analysis: diabetes, obesity,
alcohol, NSAIDs, duration of surgery, and surgical experience.
Conclusion: Independent of other risk factors, smoking is predictive for post-mastectomy wound
infection, skin flap necrosis, and epidermolysis.
Keywords
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Article info
Publication history
Accepted:
April 25,
2002
Identification
Copyright
© 2002 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
