Møller Ann M, Villebro Nete, Pedersen Tom, Tønnesen Hanne
Department of Anaesthesiology, Bispebjerg University Hospital, 2400 NV, Copenhagen, Denmark.
Lancet. 2002 Jan 12;359(9301):114-7. doi: 10.1016/S0140-6736(02)07369-5.
Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement.
We did a randomised trial in three hospitals in Denmark. 120 patients were randomly assigned 6-8 weeks before scheduled surgery to either the control (n=60) or smoking intervention (60) group. Smoking intervention was counselling and nicotine replacement therapy, and either smoking cessation or at least 50% smoking reduction. An assessor, who was masked to the intervention, registered the occurrence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance. The main analysis was by intention to treat.
Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled. Thus, 52 and 56 patients, respectively, were analysed for outcome. The overall complication rate was 18% in the smoking intervention group and 52% in controls (p=0.0003). The most significant effects of intervention were seen for wound-related complications (5% vs 31%, p=0.001), cardiovascular complications (0% vs 10%, p=0.08), and secondary surgery (4% vs 15%, p=0.07). The median length of stay was 11 days (range 7-55) in the intervention group and 13 days (8-65) in the control group.
An effective smoking intervention programme 6-8 weeks before surgery reduces postoperative morbidity, and we recommend, on the basis of our results, this programme be adopted.
吸烟者比非吸烟者发生心肺及伤口相关术后并发症的风险更高。我们的目的是研究术前吸烟干预对接受髋膝关节置换术患者术后并发症发生率的影响。
我们在丹麦的三家医院进行了一项随机试验。120例患者在预定手术前6 - 8周被随机分为对照组（n = 60）或吸烟干预组（60例）。吸烟干预包括咨询和尼古丁替代疗法，目标是戒烟或至少减少50%的吸烟量。一名对干预不知情的评估人员记录心肺、肾脏、神经或手术并发症的发生情况以及住院时间。主要分析采用意向性分析。
最终分析排除了8例对照组患者和4例干预组患者，因为他们的手术被推迟或取消。因此，分别对52例和56例患者的结局进行了分析。吸烟干预组的总体并发症发生率为18%，对照组为52%（p = 0.0003）。干预对伤口相关并发症（5%对31%，p = 0.001）、心血管并发症（0%对10%，p = 0.08）和二次手术（4%对15%，p = 0.07）的影响最为显著。干预组的中位住院时间为11天（范围7 - 55天），对照组为13天（8 - 65天）。
术前6 - 8周有效的吸烟干预计划可降低术后发病率，基于我们的研究结果，我们建议采用该计划。
