Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Spine (Phila Pa 1976). 2013 Jul 1;38(15):1294-302. doi: 10.1097/BRS.0b013e31828e2747.
Retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement database.
We assessed whether preoperative cigarette smoking and smoking duration predicted adverse, early, perioperative outcomes in patients undergoing elective spine surgery.
Prior studies have assessed the association of smoking and long-term outcomes for a number of spine surgery procedures, with conflicting findings. The association between smoking and 30-day outcomes for spine surgery is unknown.
A total 14,500 adults, classified as current (N = 3914), prior (N = 2057), and never smokers. Using propensity scores, current and prior smokers were matched to never smokers. Logistic regression was used to predict adverse postoperative outcomes. The relationship between pack-years and adverse outcomes was tested. Sensitivity analyses were conducted limiting the study sample to patients who underwent spine fusion (N = 4663), and using patient subgroups by procedure.
In unadjusted analyses, prior smokers were significantly more likely to have prolonged hospitalization (1.2, 95% confidence interval [CI]: 1.1-1.3) and major complications (1.3, 95% CI: 1.1-1.6) compared with never smokers. No association was found between smoking status and adverse outcomes in adjusted, matched patient models. Current smokers with more than 60 pack-years were more likely to die within 30 days of surgery (3.0, 95% CI, 1.1-7.8), compared with never smokers. Sensitivity analyses confirmed these findings.
The large National Surgical Quality Improvement population was carefully matched for a wide range of baseline comorbidities, including 29 variables previously suggested to influence perioperative outcomes. Although previous studies conducted in subgroups of spine surgery patients have suggested a deleterious effect for smoking on long-term outcomes in patients undergoing spine surgery, our analysis did not find smoking to be associated with early (30 d) perioperative morbidity or mortality.
回顾性分析前瞻性收集的美国外科医师学会国家手术质量改进数据库。
我们评估了术前吸烟和吸烟持续时间是否预测接受择期脊柱手术患者的不良、早期围手术期结局。
先前的研究评估了吸烟与多种脊柱手术程序的长期结果之间的关联，结果存在冲突。吸烟与脊柱手术 30 天结局之间的关系尚不清楚。
共纳入 14500 名成年人，分为当前吸烟者（N=3914）、既往吸烟者（N=2057）和从不吸烟者。使用倾向评分，将当前吸烟者和既往吸烟者与从不吸烟者进行匹配。使用逻辑回归预测不良术后结局。测试了吸烟年限与不良结局之间的关系。进行了敏感性分析，将研究样本限制为接受脊柱融合术的患者（N=4663），并按手术程序对患者亚组进行分析。
在未调整的分析中，与从不吸烟者相比，既往吸烟者术后住院时间延长（1.2，95%置信区间[CI]：1.1-1.3）和发生重大并发症的风险更高（1.3，95% CI：1.1-1.6）。在调整后的匹配患者模型中，吸烟状态与不良结局之间没有关联。与从不吸烟者相比，每天吸烟超过 60 支且持续吸烟超过 60 年的当前吸烟者术后 30 天内死亡的风险更高（3.0，95% CI，1.1-7.8）。敏感性分析证实了这些发现。
该大型国家手术质量改进数据库对广泛的基线合并症进行了仔细匹配，包括 29 个先前被认为影响围手术期结局的变量。尽管先前在脊柱手术患者亚组中进行的研究表明吸烟对脊柱手术患者的长期结局有不良影响，但我们的分析并未发现吸烟与早期（30 天）围手术期发病率或死亡率相关。
