Anastomotic Leakage in Colorectal Surgery: The Differential Impact of Smoking and Vaping

Abstract Background: Anastomotic dehiscence is a serious complication in colorectal surgery. While traditional smoking is a known independent risk factor, the impact of the growing habit of vaping on postoperative outcomes, particularly on wound healing and anastomotic integrity, is not well understood. Objective: To evaluate the association between traditional smoking, vaping, and the incidence of anastomotic dehiscence in a cohort of patients undergoing colorectal surgery. Methods: We conducted a retrospective cohort study of 748 patients who underwent elective colorectal surgery. Data on smoking and vaping habits, BMI, surgical type, and patient demographics were analyzed. We used logistic regression to identify independent risk factors for anastomotic dehiscence and other postoperative complications. Results: The overall rate of anastomotic dehiscence was 5.2%. We found that traditional smoking was an independent risk factor for anastomotic dehiscence (OR: 1.8, 95% CI: 1.2-2.7, p<0.01) as well as for wound complications, pulmonary complications, and sepsis. Interestingly, no significant association was found between vaping and anastomotic dehiscence (OR: 1.1, 95% CI: 0.8-1.5, p=0.52). Conclusion: Traditional smoking is a significant and independent risk factor for anastomotic dehiscence and other major postoperative complications in patients undergoing colorectal surgery. These findings underscore the critical importance of implementing preoperative smoking cessation programs. In contrast, no significant association was found for vaping, suggesting different effects on surgical outcomes, which warrants further investigation.