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Smoking was an independent risk factor for surgical site infection (OR = 38.3)Jain RK, Shukla R, Singh P, Kumar R. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Traumatol. 2015 Feb;25(2):251-4.


Smoking significantly increased the risk of nonunion of fractures overall, tibial fractures, and open fractures. Nonsignificant trends showed increased time to union in all fractures and toward increased postoperative rates of superficial and deep infections in smokers. Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014 Apr 16;96(8):674-81


Evidence strongly suggests that smoking is an independent risk factor for surgical site infection after spinal surgeryXing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R.A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J. 2013 Mar;22(3):605-15.


Nicotine administration potentiates the delay in wound closure observed in mice submitted to stressde Almeida TF, Romana-Souza B, Machado S, Abreu-Villaça Y, Monte-Alto-Costa A. Nicotine affects cutaneous wound healing in stressed mice. Exp Dermatol. 2013 Aug;22(8):524-9.


Current smoking at the time of elective total hip or knee replacement is associated with increased postarthroplasty complications, especially surgical site infections and pneumoniaSingh JA, Houston TK, Ponce BA, Maddox G, Bishop MJ, Richman J, Campagna EJ, Henderson WG, Hawn MT. Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res (Hoboken). 2011 Oct;63(10):1365-74.


Wound inflammation and fibroblast proliferation were attenuated in smokers, suggesting delayed healing. Abstinence from smoking restores inflammation, but does not affect proliferationSørensen LT, Toft B, Rygaard J, Ladelund S, Teisner B, Gottrup F. Smoking attenuates wound inflammation and proliferation while smoking cessation restores inflammation but not proliferation. Wound Repair Regen. 2010 Mar-Apr;18(2):186-92


Smoking not identified as a risk factor for increased "major" complication rates in cosmetic breast surgeryHanemann MS Jr, Grotting JC. Evaluation of preoperative risk factors and complication rates in cosmetic breast surgery. Ann Plast Surg. 2010 May;64(5):537-40.


Perioperative supplemental oxygen therapy exerts a significant beneficial effect in the prevention of surgical site infectionsQadan M, Akça O, Mahid SS, Hornung CA, Polk HC Jr. Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg. 2009 Apr;144(4):359-66.


Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery. Meyhoff CS, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA. 2009 Oct 14;302(14):1543-50.


Surgical site infections following elective abdominoplasty were highly correlated with the number of cigarettes per day , the years of smoking , and estimated overall number of cigarettesAraco A, Gravante G, Sorge R, Araco F, Delogu D, Cervelli V. Wound infections in aesthetic abdominoplasties: the role of smoking. Plast Reconstr Surg. 2008 May;121(5):305e-310e.


Nicotine accelerated angiogenesis and promoted wound healing at a low concentrationMorimoto N, Takemoto S, Kawazoe T, Suzuki S. Nicotine at a low concentration promotes wound healing. J Surg Res. 2008 Apr;145(2):199-204.


Smoking is associated with a higher risk of wound complication following diagnostic skin biopsyWahie S, Lawrence CM. Wound complications following diagnostic skin biopsies in dermatology inpatients. Arch Dermatol. 2007 Oct;143(10):1267-71.


Smokers have a worse functional outcome following primary reconstruction of the ACLKarim A, Pandit H, Murray J, Wandless F, Thomas NP. Smoking and reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2006 Aug;88(8):1027-31.


Nicotine caused a delay in tendon-to-bone healing in a rat rotator cuff animal modelGalatz LM, Silva MJ, Rothermich SY, Zaegel MA, Havlioglu N, Thomopoulos S. Nicotine delays tendon-to-bone healing in a rat shoulder model. J Bone Joint Surg Am. 2006 Sep;88(9):2027-34.


Smokers have a greater complication risk for surgical wounds, which cause aesthetically more undesirable scars than observed in nonsmokersRogliani M, Labardi L, Silvi E, Maggiulli F, Grimaldi M, Cervelli V. Smokers: risks and complications in abdominal dermolipectomy. Aesthetic Plast Surg. 2006 Jul-Aug;30(4):422-4.


Abstinence from smoking did not affect the skin deposition of hydroxyproline, proline, or type I procollagen. During abstinence, the type I procollagen level increased by 18% in the transdermal nicotine patches group and decreased by 10% in the placebo groupSørensen LT, Jorgensen LN, Zillmer R, Vange J, Hemmingsen U, Gottrup F. Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers. Wound Repair Regen. 2006 May-Jun;14(3):247-51.


Smoking was the only modifiable risk factor and preoperative smoking cessation may improve surgical outcomes in ventral hernia repair. Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT. Predictors of wound infection in ventral hernia repair. Am J Surg. 2005 Nov;190(5):676-81.


Patients receiving supplemental inspired oxygen had a 40% reduction in the risk of wound infectionBelda FJ, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA. 2005 Oct 26;294(16):2035-42.


Preoperative smoking abstinence of longer than 3 weeks reduces the incidence of impaired wound healing among patients who have undergone reconstructive head and neck surgeryKuri M, Nakagawa M, Tanaka H, Hasuo S, Kishi Y. Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery. Anesthesiology. 2005 May;102(5):892-6.


The risk ratio for smokers to develop complications during bone healing was 2.5, as compared to nonsmokers; smokers required an average of 16 days more in external fixationW-Dahl A, Toksvig-Larsen S: Cigarette smoking delays bone healing: A prospective study of 200 patients operated on by the hemicallotasis technique. Acta Orthop Scand 2004; 75:347–51


Nicotine acts as a potent angiogenic agent by hijacking endogenous nicotinic cholinergic pathways present in endothelial cells, involving physiological and pathological angiogenesisCooke JP, Bitterman H: Nicotine and angiogenesis: A new paradigm for tobacco-related diseases. Ann Med 2004; 36:33–40


Smoking is the single most important risk factor for the development of postoperative complications, especially those relating to wound healingMøller AM, Pedersen T, Villebro N, Munksgaard A: Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br 2003; 85:178–81


In smokers the wound infection rate was 12% compared with 2% in never-smokers. Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4, 8, and 12 weeks after randomizationSorensen LT, Karlsmark T, Gottrup F: Abstinence from smoking reduces incisional wound infection: A randomized controlled trial. Ann Surg 2003; 238:1–5


When compared to non-smoking, heavy- and light-smoking were significantly associated with wound infection after all types of surgery, skin flap necrosis, and epidermolysis after simple mastectomy and modified radical mastectomy, with odds ratios ranging from 3.0 to 9.0. Sorensen LT, Horby J, Friis E, Pilsgaard B, Jorgensen T: Smoking as a risk factor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol 2002; 28:815–20


Nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery; patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR: The effect of cigarette smoking and smoking cessation on spinal fusion. Spine 2000; 25:2608–15


Nonsmokers had a 1.8 times higher median levels of hydroxyproline than smokers; deposition of hydroxyproline was negatively correlated with the consumption of tobacco both before and during the studyJorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F: Less collagen production in smokers. Surgery 1998; 123:450–5


Current smokers had necrosis develop approximately three times more frequently than never smokers with a median percent of the visible graft tissue that necrosed approximately threefold greater as compared to never smokers. Goldminz D, Bennett RG: Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatol 1991; 127:1012–5