Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Affairs Hospital, Birmingham, AL 35294, USA.
Ann Surg. 2011 Dec;254(6):914-20. doi: 10.1097/SLA.0b013e31822d7f81.
This study aimed to assess the attributable risk and potential benefit of smoking cessation on surgical outcomes.
Risk reduction with the implementation of surgical care improvement project process measures has been the primary focus for improving surgical outcomes. Little emphasis has been placed on preoperative risk factor recognition and intervention.
A retrospective cohort analysis of elective operations from 2002 to 2008 in the Veterans Affairs Surgical Quality Improvement Program for all surgical specialties was performed. Patients were stratified by current, prior, and never smokers. Adjusted risk of complication and death was calculated using multilevel, multivariable logistic regression.
Of 393,794 patients, 135,741 (34.5%) were current, 71,421 (18.1%) prior, and 186,632 (47.4%) never smokers. A total of 6225 pneumonias, 11,431 deep and superficial surgical-site infections, 2040 thromboembolic events, 1338 myocardial infarctions, and 4792 deaths occurred within 30 days of surgery. Compared with both never and prior smokers individually and controlled for patient and procedure risk factors, current smokers had significantly more postoperative pneumonia, surgical-site infection, and deaths (P < 0.001 for all). There was a dose-dependent increase in pulmonary complications based on pack-year exposure with greater than 20 pack years leading to a significant increase in smoking-related surgical complications.
This is the first study to assess the risk of current versus prior smoking on surgical outcomes. Despite being younger and healthier, current smokers had more adverse perioperative events, particularly respiratory complications. Smoking cessation interventions could potentially reduce the occurrence and costs of adverse perioperative events.
本研究旨在评估戒烟对手术结果的可归因风险和潜在益处。
通过实施外科护理改进项目过程措施来降低风险一直是改善手术结果的主要关注点。但术前危险因素的识别和干预并没有得到太多重视。
对退伍军人事务部外科质量改进计划所有外科专业的 2002 年至 2008 年择期手术进行回顾性队列分析。患者按当前、既往和从不吸烟者分层。使用多层次、多变量逻辑回归计算并发症和死亡的调整风险。
在 393794 名患者中，135741 名（34.5%）为当前吸烟者，71421 名（18.1%）为既往吸烟者，186632 名（47.4%）为从不吸烟者。术后 30 天内共发生 6225 例肺炎、11431 例深部和浅部手术部位感染、2040 例血栓栓塞事件、1338 例心肌梗死和 4792 例死亡。与从不吸烟者和既往吸烟者相比，当前吸烟者术后肺炎、手术部位感染和死亡的发生率显著更高（所有 P 值均<0.001）。基于吸烟包年暴露量，存在与肺部并发症呈剂量依赖性增加的趋势，吸烟量超过 20 包年与吸烟相关的手术并发症显著增加相关。
这是第一项评估当前与既往吸烟对手术结果风险的研究。尽管当前吸烟者更年轻、更健康，但他们围手术期不良事件更多，尤其是呼吸系统并发症。戒烟干预措施可能会降低不良围手术期事件的发生和成本。
