Smoking May Increase Risk for Acute Complications Following Mohs Reconstruction

Smoking is an important lifestyle factor to consider for preoperative Mohs surgery planning.

Both current and former smokers may be at increased risk for acute complications following Mohs micrographic surgery reconstruction, a study published in JAMA Facial Plastic Surgery suggests.

Investigators conducted a retrospective case-control study of patients who underwent Mohs reconstruction repaired by flap or graft between July 1, 2012, and June 30, 2016, at a single tertiary referral center in St Louis, Missouri. Patients were selected by consecutive sampling. Exclusion criteria included incomplete records and the use of a single flap or graft to repair multiple defects. Patient demographic and clinical information was obtained through medical record review. Smoking status was classified as current, former, or never. As primary outcome measures, investigators captured both acute and long-term complications. Multivariable logistic regression analysis was performed to identify predictors of acute and long-term complications.

A total of 1008 patients were included in the study, among whom 612 (60.7%) were men. The median (standard deviation) age was 70 (12) years (range, 12-90 years). A total of 128 patients (12.7%) were current smokers, while 385 (38.2%) and 495 (49.1%) identified as former and never smokers, respectively. Multivariable logistic regression showed that current smoking (odds ratio [OR], 9.58; 95% CI, 3.63-25.3), former smoking (OR, 3.64; 95% CI, 1.41-9.38), larger defect size (OR, 2.25; 95% CI, 1.58-3.20), and use of a free cartilage graft (OR, 8.19; 95% CI, 2.02-33.1) were associated with increased risk for acute complications. Central face location (OR, 25.4; 95% CI, 6.16-106.5), use of interpolation flap or flap-graft combination (OR, 3.49; 95% CI, 1.81-6.74), larger flap size (OR, 1.42; 95% CI, 1.09-1.87), and the presence of basal cell carcinomas or other basaloid tumors (OR, 3.43; 95% CI, 1.03-.11.5) were associated with increased risk for long-term complications. For each 10-year increase in age, the odds for long-term complications decreased by 0.66 (95% CI, 0.54-0.80).

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Limitations of the study include its less-generalizable results from a single center. Other limitations include the retrospective nature and quality of the study data source, which relied on documentation in patient medical records. There was no photographic documentation to allow objective outcome measures.

These data indicate that any exposure to smoking, current or former, may increase risk for postsurgical acute complications. However, smoking was not associated with long-term complications. Surgeons may find these data useful in quantifying the risk magnitude for certain patients prior to Mohs reconstruction, the investigators concluded.

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Wang CY, Dudzinski J, Nguyen D, Armbrecht E, Maher IA. Association of smoking and other factors with the outcome of Mohs reconstruction using flaps or grafts [published online June 13, 2019]. JAMA Facial Plast Surg. doi:10.1001/jamafacial.2019.0243