Introduction

A recent systematic review has thrown a spotlight on the relationship between smoking and surgical outcomes for patients suffering from hidradenitis suppurativa (HS). Conducted by a team including Akash Rau, an MD candidate from Michigan State University, the review raises questions about the previously assumed impact of smoking on these surgical procedures.

Understanding Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic skin condition characterized by painful lumps under the skin, commonly in areas like armpits and groin. Its management often requires surgical interventions, ranging from lesional deroofing to extensive excisions of affected skin. Given the complexity of HS, every detail in treatment can significantly impact patient well-being and recovery.

Research Focus and Methodology

Rau and colleagues pointed out existing literature indicating a potential connection between smoking, obesity, and HS, but noted, "There are limited studies assessing this relationship." Their comprehensive analysis aimed to fill this research void by identifying randomized controlled trials and observational studies that examined how tobacco use affects surgical outcomes in HS patients.

In December 2022, the team meticulously combed through various databases, including PubMed and Scopus, yielding an impressive collection of 4,348 articles. After excluding duplicates, they narrowed it down to 22 studies that met specific inclusion criteria, examining a total of 3,104 patients, with 1,539 identified as smokers.

Findings and Implications

Surprisingly, even among the studies that employed statistical analyses on 2,831 patients, no significant correlation was found between smoking and adverse surgical outcomes. However, the six studies lacking detailed statistical evaluations indicated an alarming trend: higher complication rates in smokers, which could be a cause for concern.

For instance, smokers exhibited significantly higher delayed HS recurrence rates—20.6% compared to just 5.45% among non-smokers.

Recommendations for Patients

The researchers underscored the importance of pre-surgical tobacco cessation, recommending patients quit smoking 1 to 2 months before undergoing procedures. However, their findings reveal a need for further research that takes into account critical factors such as participants' sex, age, race, lesion size, HS staging, and comorbidities, which were not controlled in the studies they reviewed.

Conclusion and Future Research

Highlighting the inherent limitations in existing research, the team pointed out a lack of standardized definitions for surgical outcomes in HS, with clear distinctions needed between local recurrence and disease recurrence at distant sites. "Further studies with matched patients can provide deeper insights into the association between smoking and surgical wound healing in HS patients," they concluded.

With many questions left unanswered, this study emphasizes the complexity of HS and the multifaceted nature of its treatment, while reinforcing that quitting smoking is still a prudent step for individuals considering surgical options. More research is essential to ensure that patients can achieve the best outcomes possible in their fight against this challenging condition.