CIGARETTE SMOKING AND SURGICAL WOUND HEALING: A PROSPECTIVE COMPARATIVE COHORT STUDY OF POSTOPERATIVE OUTCOMES AT A TERTIARY CARE CENTRE IN SOUTH INDIA

Background: Cigarette smoking is a well-recognised, modifiable determinant of impaired tissue repair, yet comparative data quantifying its effect on postoperative wound outcomes remain limited in South Asian surgical populations, particularly when weighed against common comorbidities such as diabetes and hypertension. Objectives: To compare postoperative recovery, wound healing status, pain trajectory, and complication rates between smokers and non-smokers undergoing clean and clean-contaminated surgery, and to determine whether smoking, diabetes, or hypertension independently predict delayed healing. Methods: A six-month prospective observational cohort study was conducted at Basaveshwara Medical College Hospital & Research Centre, Chitradurga, following institutional ethics committee approval. Two hundred and twenty adult postoperative patients were enrolled and allocated to a smoker group (n=110) or a non-smoker group (n=110). Demographic data, comorbidity status, and smoking history were captured with a structured questionnaire, and wounds were assessed serially on postoperative days 4, 7, 10, and 15 using standard clinical wound-grading criteria. Group comparisons used chi-square and independent-samples t-tests, and multivariate logistic regression was used to identify independent predictors of delayed healing. Results: The two groups were age-matched (p=0.747); smoking was confined to male participants. Healthy wound healing was achieved by 83.6% of non-smokers versus 60.9% of smokers, while delayed healing was more than twice as frequent among smokers (39.1% vs 16.4%; p<0.001). Postoperative infection occurred in 10.0% of smokers compared with 2.7% of non-smokers (p=0.050). Smokers reported significantly higher pain scores on postoperative days 4, 10, and 15 (p<0.001 for each), with no significant between-group difference on day 7 (p=0.245). On multivariate logistic regression, smoking was the only independent predictor of impaired healing (odds ratio 0.32, 95% confidence interval 0.17–0.60, p<0.001); diabetes, hypertension, and their coexistence did not reach statistical significance. Conclusion: Smoking is a dominant, independent, and modifiable risk factor for delayed surgical wound healing, higher infection rates, and greater postoperative pain, with an effect that outweighs that of diabetes or hypertension in this cohort. Structured preoperative smoking-cessation counselling should be prioritised in surgical care pathways.