Goltsman David, Munabi Naikhoba C O, Ascherman Jeffrey A
New York, N.Y.; and Sydney, New South Wales, Australia.
From the Division of Plastic Surgery, Columbia University Medical Center, New York-Presbyterian Hospital; and the Department of Plastic Surgery, Prince of Wales Hospital.
Plast Reconstr Surg. 2017 Feb;139(2):503-511. doi: 10.1097/PRS.0000000000002958.
Smoking is known to negatively impact postoperative wound healing and increase infection risk. However, few studies have investigated whether the negative effects of smoking are similar for different procedures. The authors examined the association between smoking and postoperative outcomes for a diverse range of plastic surgery procedures.
Using the American College of Surgeons National Surgical Quality Improvement Program data set, demographics and outcomes were examined for patients who underwent plastic surgery between 2007 and 2012. Multivariable logistic regression models assessed the relationship between smoking status and a range of postoperative outcomes, including medical and surgical complications and impaired wound healing. Patients were also evaluated for length of inpatient hospitalization while controlling for multiple demographic factors and type of procedure.
Forty thousand four hundred sixty-five patients were identified from the data set, including patients who had undergone breast, upper and lower extremity, abdominal, and craniofacial procedures. Current smokers constituted 15.7 percent of the cohort. Smokers had a higher likelihood of surgical (OR, 1.37; p < 0.0001) and medical complications (OR, 1.24; p = 0.0323) and increased odds for wound complications (OR, 1.49; p < 0.0001) and wound dehiscence (OR, 1.84; p < 0.0001). Smokers were also found to have increased odds of these complications even when subgroup analysis was performed according to major Current Procedural Terminology categories. Smoking also increased the odds of superficial wound infections (OR, 1.40; p < 0.0001). No difference was observed in hospital length of stay between smokers and nonsmokers.
Smoking increases a multitude of postoperative complications after plastic surgery procedures. The effects of smoking on plastic surgery outcomes should be used to guide patients in preoperative smoking cessation and to evaluate protocols for managing patients who smoke.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
众所周知，吸烟会对术后伤口愈合产生负面影响并增加感染风险。然而，很少有研究调查吸烟对不同手术的负面影响是否相似。作者研究了吸烟与各种整形手术术后结果之间的关联。
利用美国外科医师学会国家外科质量改进计划数据集，对2007年至2012年间接受整形手术的患者的人口统计学和结果进行了检查。多变量逻辑回归模型评估了吸烟状况与一系列术后结果之间的关系，包括医疗和手术并发症以及伤口愈合受损。在控制多种人口统计学因素和手术类型的同时，还对患者的住院时间进行了评估。
从数据集中识别出44665名患者，包括接受乳房、上肢和下肢、腹部以及颅面手术的患者。当前吸烟者占队列的15.7%。吸烟者发生手术并发症（比值比[OR]，1.37；P<0.0001）和医疗并发症（OR，1.24；P = 0.0323）的可能性更高，伤口并发症（OR，1.49；P<0.0001）和伤口裂开（OR，1.84；P<0.0001）的几率增加。即使根据主要的当前程序术语类别进行亚组分析，也发现吸烟者发生这些并发症的几率增加。吸烟还增加了浅表伤口感染的几率（OR，1.40；P<0.0001）。吸烟者和非吸烟者的住院时间没有差异。
吸烟会增加整形手术后多种术后并发症的发生。吸烟对整形手术结果的影响应用于指导患者术前戒烟，并评估管理吸烟患者的方案。
临床问题/证据级别：风险，II级。
