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Invited Critique |

Kicking Society's Tobacco Habit:  Comment on “The Clinical Effect of Smoking and Smoking Cessation on Wound Healing and Infection in Surgery”

Desmond C. Winter, MD
Arch Surg. 2012;147(4):383. doi:10.1001/archsurg.2012.43.
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An astonishing 1 in 5 US adults are current smokers (≥100 lifetime cigarettes and regular consumption).1 Although this figure has declined a little recently, the overhanging health issues will persist for some time. The current findings of adverse effects on surgical site infections and reparative processes are less surprising.2 However, can we confidently determine inhaled tobacco smoke as an isolated risk factor with the current study design? There are far too many covariables to digest. Smokers tend to be in lower socioeconomic groups, be more sedentary, drink more alcohol, and have more comorbidities than current nonsmokers (ex-smokers) and never (life-long tobacco-free) smokers. The inadequate power of the studies, the well-recognized inaccuracy with which patients report their smoking habits, and the haziness of wound-healing definition (eg, rate of healing, time to complete closure, patient satisfaction, self-assessed or surgical scores?) are prohibitive impediments to present data interpretation and the call for future trials.

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