Selvarajah Shalini, Ahmed Ammar A, Schneider Eric B, Canner Joseph K, Pawlik Timothy M, Abularrage Christopher J, Hui Xuan, Schwartz Diane A, Hisam Butool, Haider Adil H
Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Surg Res. 2014 Nov;192(1):41-9. doi: 10.1016/j.jss.2014.06.014. Epub 2014 Jun 13.
In the United States, approximately 800,000 cholecystectomies are performed annually. We sought to determine the influence of preoperative smoking on postcholecystectomy wound complication rates.
Using the National Surgical Quality Improvement Program database (2005-2011), patients aged ≥18 y who underwent elective open or laparoscopic cholecystectomy (LC) for benign gallbladder disease were identified using current procedural terminology codes. Multivariate regression was performed to determine the association between smoking status and wound complications, by surgical approach.
Of 143,753 identified patients, 128,692 (89.5%) underwent LC, 27,788 (19.3%) were active smokers, and 100,710 (70.2%) were females. Active smokers were younger than nonsmokers (mean + standard deviation age: 44.2 (14.9) versus 51.6 (17.9) years); P < 0.001) and had fewer comorbidities. Within 30-d postcholecystectomy, wound complications were reported in 2011 (1.4%) patients. Compared with nonsmokers, active smokers demonstrated increased odds of wound complications after both open cholecystectomy (odds ratio 1.28; P = 0.010) and LC (odds ratio 1.20; P = 0.020) after adjustment for demographic and clinical characteristics. Having wound complications increased the average postoperative length of stay by 2-4 d (P <0.001).
Active smokers are more likely to develop wound complications after cholecystectomy, regardless of surgical approach. Occurrence of wound complications consequently increases postoperative length of stay. Smoking abstinence before cholecystectomy may reduce the burden associated with wound complications.
在美国，每年大约进行80万例胆囊切除术。我们试图确定术前吸烟对胆囊切除术后伤口并发症发生率的影响。
利用国家外科质量改进计划数据库（2005 - 2011年），使用当前手术操作术语编码识别年龄≥18岁、因良性胆囊疾病接受择期开放或腹腔镜胆囊切除术（LC）的患者。通过手术方式进行多变量回归分析，以确定吸烟状况与伤口并发症之间的关联。
在143,753例已识别患者中，128,692例（89.5%）接受了LC，27,788例（19.3%）为现吸烟者，100,710例（70.2%）为女性。现吸烟者比不吸烟者年轻（平均±标准差年龄：44.2（14.9）岁对51.6（17.9）岁；P < 0.001），且合并症较少。在胆囊切除术后30天内，2011例（1.4%）患者报告有伤口并发症。在调整人口统计学和临床特征后，与不吸烟者相比，现吸烟者在开放胆囊切除术后（比值比1.28；P = 0.010）和LC术后（比值比1.20；P = 0.020）出现伤口并发症的几率均增加。发生伤口并发症使术后平均住院时间延长2 - 4天（P < 0.001）。
无论手术方式如何，现吸烟者在胆囊切除术后更易发生伤口并发症。伤口并发症的发生会增加术后住院时间。胆囊切除术前戒烟可能会减轻与伤口并发症相关的负担。
