The effect of smoking on perioperative complications in head and neck oncologic surgery

Objectives/Hypothesis: Cigarette smoking is the most important risk factor for head and neck cancer. Conventional wisdom suggests that smoking causes increased postoperative wound healing and systemic complications in this patient population, but it is unclear if the clinical literature supports this. Study Design: Systematic review. Methods: The authors performed a review of the literature from 1990 to 2010 on the effect of cigarette smoking on perioperative complications in head and neck surgery. Results: Thirty-six articles met eligibility criteria and were reviewed; 14 focused on extirpative surgery and 22 on reconstruction. Most of the evidence was comprised of case series and small cohort studies. We reviewed local wound healing and systemic complications, and 47% of studies supported an association between smoking and complications of surgery. Conclusions: Evidence from the existing clinical literature is inconclusive on an association between cigarette smoking and perioperative complications after head and neck surgery. The negative impact of smoking is suggested; however, the majority of articles had significant methodological weaknesses. Prospective study of tobacco-induced complications is needed.