Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

August 27, 2020; Updated January 19, 2022.

Avoid elective repair of minimally symptomatic abdominal wall hernias in patients that are actively smoking.

Current smoking is an independent predictor of perioperative morbidity. In the hernia literature specifically, smoking has been associated with increased risk of wound infection, major operative complications, readmission, and perioperative respiratory complications in addition to increased risk of hernia recurrence. As an independent and modifiable predictor of worsened outcomes, avoiding elective surgery in the setting of smoking may ultimately contribute to improved post-operative outcomes.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


Borad NP, Merchant AM. The effect of smoking on surgical outcomes in ventral hernia repair: a propensity score matched analysis of the National Surgical Quality Improvement Program data. Hernia. 2017 Dec 1;21(6):855–67.

Fischer JP, Wink JD, Nelson JA, Kovach SJ. Among 1,706 cases of abdominal wall reconstruction, what factors influence the occurrence of major operative complications? Surgery [Internet]. 2014 Feb [cited 2020 Mar 10];155(2):311–9. Available from:

Lindström D, Azodi OS, Wladis A, Tønnesen H, Linder S, Nåsell H, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: A randomized trial. Ann Surg [Internet]. 2008 Nov [cited 2020 Mar 10];248(5):739–45. Available from: