Preoperative Optimization of the Hernia Patient

Smokers are twice as likely to develop a hernia recurrence after repair (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.23–3.47).

Smokers are more than twice as likely to develop a wound complication (OR 2.27; 95% CI, 1.82–2.84).

Wound infection rates are higher in smokers (OR 1.79; 95% CI, 1.57–2.04).

Smoking cessation for a minimum of 4 weeks before hernia repair is recommended.

Randomized trials of short-term cessation (≤3 weeks) have not shown efficacy.

Nicotine replacement therapy is acceptable.

A serum cotinine level will not be affected by nicotine replacement therapy.

A serum cotinine level is able to confirm 2 weeks of abstinence.

Extensive patient counseling is offered.

If a disingenuous report of cigarette abstinence is suspected, a serum cotinine level is obtained during preadmission testing.

A patient’s failure to quit smoking by the second clinic visit delays the operation by 6 months.

A second failure results in the patient being released from the practice.

Electronic cigarettes (“e-cigarettes”) have not been regulated by the U.S. Food and Drug Administration, and their safety is unknown. Studies have demonstrated the presence of the same toxic compounds found in cigarettes in varying concentrations that are not reported to the consumer. The Food and Drug Administration is currently attempting to expand its authority to regulate such products. In the meantime, we do not allow patients to use e-cigarettes.