Martin Christopher T, Gao Yubo, Duchman Kyle R, Pugely Andrew J
From The Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City.
Spine (Phila Pa 1976). 2016 Apr;41(7):577-84. doi: 10.1097/BRS.0000000000001281.
A retrospective review of prospectively collected data.
The aim of this study was to determine the impact of current smoking or prior smoking cessation on 30-day morbidity risk following lumbar spine surgery.
Prior studies have reported conflicting data regarding the impact of smoking on morbidity risk, and few studies have investigated smoking cessation.
A large, multicenter, prospectively collected clinical registry was queried for all adult patients undergoing lumbar spine surgery in 2012 and 2013, and 35,477 cases were identified. Morbidity data are collected by on-site clinical personnel for 30 days postoperatively. Patients were divided into categories of "never-smoker," for patients with no reported cigarette use (n = 27,246), "former smoker," for patients who quit smoking more than 12 months before surgery (n = 562), and "current smoker," for patients still using cigarettes (n = 7669). A univariate analysis was conducted to identify un-adjusted differences in morbidity risk, and a multivariate analysis was conducted in an attempt to control for confounders.
In the multivariate analysis, current smokers had a significantly higher risk of both superficial surgical site infection and overall wound complications, than never-smokers (P < 0.05 for each). Current smokers also had a significantly higher risk of total 30-day morbidity (P = 0.04). There was a trend toward former smokers also having an increased risk, but this did not reach significance in any category. Patients with a pack-year smoking history of 1 to 20 pack-years and more than 40 pack-years both had a significantly higher risk of superficial surgical site infections (P < 0.05 for each).
Current smoking is associated with a small but significant increase in systemic morbidity and wound complications following elective lumbar spine procedures. Increasing pack year history was also associated with wound complication risk, suggesting a dose-related effect. The data provide preliminary support for future studies on smoking cessation.
对前瞻性收集的数据进行回顾性分析。
本研究旨在确定当前吸烟或既往戒烟对腰椎手术后30天发病风险的影响。
既往研究报告了关于吸烟对发病风险影响的相互矛盾的数据，且很少有研究调查戒烟情况。
查询一个大型多中心前瞻性收集的临床登记库，纳入2012年和2013年接受腰椎手术的所有成年患者，共识别出35477例病例。发病数据由现场临床人员在术后30天收集。患者分为“从不吸烟者”（未报告吸烟的患者，n = 27246）、“既往吸烟者”（术前12个月以上戒烟的患者，n = 562）和“当前吸烟者”（仍在吸烟的患者，n = 7669）。进行单因素分析以确定发病风险的未调整差异，并进行多因素分析以控制混杂因素。
在多因素分析中，当前吸烟者发生浅表手术部位感染和总体伤口并发症的风险均显著高于从不吸烟者（每项P < 0.05）。当前吸烟者30天总发病风险也显著更高（P = 0.04）。既往吸烟者也有风险增加的趋势，但在任何类别中均未达到显著水平。吸烟史为1至20包年和超过40包年的患者发生浅表手术部位感染的风险均显著更高（每项P < 0.05）。
当前吸烟与择期腰椎手术后全身发病率和伤口并发症的小幅但显著增加相关。吸烟包年数增加也与伤口并发症风险相关，提示存在剂量相关效应。这些数据为未来戒烟研究提供了初步支持。
3级。
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