Smoking and Hypoalbuminemia as Risk Factors for Postoperative Complications in Reconstructive Hand and Forearm Surgery

Background and objective Limited evidence exists regarding the synergistic effects of smoking and hypoalbuminemia on postoperative complications in hand and forearm surgery. This study aimed to investigate the association between preoperative albumin levels, smoking status, and postoperative complications in US adults undergoing reconstructive procedures. Methods We conducted a retrospective cohort analysis of 20,725 adults identified in the 2011-2021 American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent reconstructive hand and forearm procedures corresponding to 43 Current Procedural Terminology (CPT) codes. Smoking within one year of surgery and preoperative albumin levels below 3.5 g/dL were treated as primary independent variables. Binary logistic regression models adjusted for potential confounders were used to estimate associations. Results Among the patients, 21.1% experienced composite complications. Most were due to prolonged hospital stays lasting more than two days (17.9%), followed by readmissions (2.6%). After adjustment, smokers exhibited higher odds of complications compared to nonsmokers (odds ratio (OR): 1.16, 95% confidence interval (CI): 1.04-1.29). Hypoalbuminemia independently increased the odds of complications by 2.5 times (OR: 2.51, 95% CI: 2.25-2.80). No evidence of interaction between hypoalbuminemia and smoking was observed (p = 0.227). Conclusions Although no significant interaction effect was observed between smoking and hypoalbuminemia, these factors were independent risk factors for postoperative complications in reconstructive hand and forearm surgery. Our findings reaffirm the importance of considering and addressing these modifiable risk factors in surgical planning for this patient population to achieve optimal post-op outcomes.