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Purpose The tobacco epidemic is one of the biggest global public health issues impacting quality of life and surgical outcomes. Although 30% of colon cancers warrant a right hemicolectomy (RH), there is no specific data on the influence of smoking on postoperative complications following RH for cancer. The aim of this study was to determine its effect on post-surgical outcomes. Methods Patients who underwent elective RH for colon cancer between 2016 and 2019 were identified from the ACS-NSQIP database. Propensity score matching (PSM) was used with a maximum absolute difference of 0.05 between propensity scores. Primary outcome was to assess the 30-day complication risk profile between smokers and non-smokers. Secondary outcomes included smoking impact on wound and major medico-surgical complication rates, as well as risk of anastomotic leak (AL) using multivariable logistic regression models. Results Following PSM, 5652 patients underwent RH for colon cancer with 1,884 (33.3%) identified as smokers. Smokers demonstrated a higher rate of organ space infection (4.1% vs 3.1%, p = 0.034), unplanned return to theatre (4.8% vs 3.7%, p = 0.045) and risk of AL (3.5% vs 2.1%, p = 0.005). Smoking was found to be an independent risk factor for wound complications (OR 1.32, 95% CI 1.03–1.71, p = 0.032), primary pulmonary complications (OR 1.50, 95% CI 1.06–2.13, p = 0.024) and AL (OR 1.66, 95% CI 1.19–2.31, p = 0.003). Conclusion Smokers have increased risk of developing major post-operative complications compared to non-smokers. Clinicians and surgeons must inform smokers of these surgical risks and potential benefit of smoking cessation prior to undergoing major colonic resection.

Background Bowel ischaemia significantly increases morbidity and mortality from adhesional small bowel obstruction. Current biomarkers and clinical parameters have poor predictive value for ischaemia. Our study investigated whether neutrophil‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR) could be used to predict bowel ischaemia in adhesional small bowel obstruction. Methods This single‐centre retrospective study collected clinical, biochemical and radiological data from patients with adhesional small bowel obstruction between 2017 and 2020 who underwent operative management. The presence or absence of bowel ischaemia/infarction was used to distinguish two populations. Biochemical markers on admission and immediately prior to operation were collected to give platelet‐lymphocyte ratio (PLR0 and PLRPRE‐OP, respectively) and neutrophil‐lymphocyte ratio (NLR0 and NLRPRE‐OP, respectively). SAS 9.4 (SAS Institute Inc., Cary, NC) software was used for data analysis with Mann–Whitney U testing for continuous variables and Pearson Chi‐square test for categorical variables. Sensitivity and specificity for PLR and NLR were calculated by means of receiver operating characteristic (ROC) curve analysis. Results Twenty‐seven patients had intra‐operative bowel ischaemia whilst the remaining 73 had no evidence of bowel ischaemia. Both median PLRPRE‐OP and NLRPRE‐OP were significantly higher in patients with bowel ischaemia compared to those without (PLRPRE‐OP 272 [IQR 224–433] and 231 [IQR 146–295] respectively, P = 0.027; NLRPRE‐OP 12.5 [IQR 8.6–21.3] v. 5.5 [IQR 3.5–10.2] respectively, P ≤ 0.001). Area under the receiver operator characteristic curve (AUC) was 0.762 for NLRPRE‐OP, with a sensitivity of 85.1% and specificity of 63% for NLR 7.4. Conclusion Raised NLR is predictive of bowel ischaemia in patients with adhesional small bowel obstruction.

Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.