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Smokers Opting For Plastic Surgery Challenge Doctors

There is no consensus on how best to treat smokers who undergo elective plastic surgery.

Surgeons would prefer to operate on non-smokers but are faced with a significant population of patients who use tobacco. Yet, no specific recommendations for performing elective procedures on these patients are available.

This type of information is needed because patient smoking status affects many aspects of plastic surgery, including patient selection, counselling, management and outcome.

Objective of this study of the planning of elective operations on patients who smoke was to determine current practice standards and attitudes to this often-controversial subject.

Participants were 955 respondents to a questionnaire sent in September 2000 to 1,600 members of the American Society for Aesthetic Plastic Surgery.

Questions measured willingness to perform various operative procedures on patients who smoke and types of smoking cessation aids offered and elicited categorical answers, either dichotomous or multiple choice.

Researchers evaluated the data using logistic regression and the chi-square and binomial tests.

Sixty percent of plastic surgeons were found routinely to perform a less than optimal procedure on their patients who smoke. Of those doctors who require patients to quit the habit before surgery, only 16.7 percent would perform a nicotine test if they suspected noncompliance.

Interestingly, 28.6 percent of respondents admit to a smoking history themselves. Only 1.5 percent, however, continue to smoke compared with the US national smoking rate of almost 25 percent.

Doctors who are previous smokers are less likely to offer smoking cessation aids than are those who have never smoked, and the proportion not offering aids increases as the amount of previous smoking increases.

Study findings suggest a wide range of opinions exist on which elective surgical procedures should be performed on patients who smoke. Furthermore, a doctor's prior smoking history influences this decision.

Concluding that no clear consensus exists on how best to treat smokers who request elective surgeries, these authors suggest advancements in wound healing research and smoking cessation aids will provide more insight into this treatment dilemma.

R J Rohrich and colleagues from the Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States did this work.
Plast Reconstr Surg 2002 Jan;109(1):350-5.

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