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Smoking And Its Complications Generate Additional Healthcare Charges Following Outpatient Plastic Surgery Procedures
Michelle R. Sieffert, MD.
Wright State University, Beavercreek, OH, USA.

PURPOSE: While smoking is associated with post-operative complications, the frequency of complications occurring that require acute hospital care is unknown. We conducted this study to determine if patients with a history of smoking experience a higher rate of hospital-based, acute care and greater healthcare charges after common outpatient plastic surgeries.
METHODS: Using state level ambulatory surgery data from four states, we identified adult patients who underwent common facial, breast, or abdominal contouring procedures from January 2009-September 2013. Our primary outcomes were hospital based, acute care encounters (inpatient admissions and emergency department visits), serious adverse events, and cumulative healthcare charges within 30 days. Multivariate regression models were used to compare outcomes between smokers and non-smokers.
RESULTS: The final sample included 214,761 patients with 10,426 (4.9%) having a smoking history. Compared to patients without a smoking history, those with a smoking history are more likely to have a hospital based acute care encounter (3.4% vs. 7.1%; AOR=1.36 [1.25-1.48]) or serious adverse event (0.9% vs. 2.2%; AOR=1.38 [1.18-1.60]) within 30 days. On average, these events added \,744 more per case for patients with a smoking history. These findings were consistent when stratified by procedure.
CONCLUSION: Patients with a smoking history undergoing outpatient plastic surgery more frequently require hospital-based acute care and generate higher healthcare charges post-operatively. This information may augment surgeon’s discussions of peri-operative risk in this population.


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