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Review
. 2023 Jan 30;12(1):112-127.
doi: 10.21037/tau-22-427. Epub 2023 Jan 3.

How and why tobacco use affects reconstructive surgical practice: a contemporary narrative review

Joshua Sterling  1   2 , Connor Policastro  1 , Jason Elyaguov  1 , Jay Simhan  3 , Dmitriy Nikolavsky  1
Affiliations
Review

How and why tobacco use affects reconstructive surgical practice: a contemporary narrative review

Joshua Sterling et al. Transl Androl Urol. .

Abstract

Background and objective: The overall negative impact of tobacco use on an individual's health has been well documented but the literature on tobacco's impact on post-surgical outcomes, specifically the outcomes after urologic surgery, is not as clear cut. The aim of this narrative review is to provide urologists with the information needed to have a nuanced pre-operative counseling conversation with patients about tobacco use. Here we combine publications on the histologic and physiologic changes induced by nicotine and tobacco use with publications from the wider surgical literature on post-operative outcomes in tobacco users.

Methods: A literature search of PubMed, Google Scholar and Medline was performed using iterations of the following terms: tobacco, nicotine, changes, physiologic, histology, post-operative, and surgical. Non-English publications and abstracts were excluded. Inclusion required agreement from all authors and preference was given to human specimens over animal models for the basic science manuscripts and large database and meta-analyses over single institution experiences.

Key content and findings: Tobacco use results in measurable changes in nearly every organ system in the body. While smokers have increased wound complications, there is no evidence that reconstructive surgery using grafts or flaps fail more frequently in tobacco users. Smokers have an increased risk of respiratory complications following endotracheal intubation.

Conclusions: Surgeries should not be canceled due to a patient's inability to cease tobacco use. Urologists and patients should engage in joint decision making regarding the timing and pursuit of elective operations.

Keywords: Tobacco; preoperative counseling; reconstructive surgery; surgical outcomes.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-427/coif). Jay Simhan serves as an unpaid editorial board member of Translational Andrology and Urology from June 2016 to July 2024. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
H&E stained buccal mucosa. (A) Representative H&E section at 40× magnification. (B) Representative H&E section at 80× magnification. H&E, Hematoxylin and Eosin.
Figure 2
Figure 2
IHC pathologic analysis of buccal mucosa. (A) IHC stain for p75 (nerve growth factor receptor), a cytoplasm localized marker, 120× magnification. (B) IHC stain for Sox2, a nucleus localized marker, 120× magnification. IHC, immunohistochemistry.
Figure 3
Figure 3
Representative hematoxylin and eosin stained and immunohistochemistry stained samples of buccal mucosa harvested from patients who never used tobacco, those who used tobacco through the time of harvest, and those who formerly used tobacco; 80× magnification. H&E, Hematoxylin and Eosin.
See this image and copyright information in PMC

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