Toyoda Yoshiko, Fu Rose H, Li Lu, Otterburn David M, Rohde Christine H
New York, N.Y.; and Plano, Texas.
From NewYork-Presbyterian Hospital/Cornell-Columbia and STATinMED Research.
Plast Reconstr Surg. 2018 Jan;141(1):226-236. doi: 10.1097/PRS.0000000000003963.
Smoking has been associated with wound healing complications and overall morbidity in multiple specialties, including plastic surgery. From 2005 to 2014, smoking prevalence among U.S. adults decreased from 20.9 percent to 16.8 percent. This study aims to investigate whether smoking prevalence among plastic surgery patients paralleled the national trend and whether smoking was an independent risk factor for postoperative complications.
The 2005 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was used to examine smoking prevalence and 30-day postoperative complications in 36,454 patients who underwent common plastic surgical procedures with extensive planes of dissection. Patients were propensity score-matched for demographics and comorbidities. Smokers were stratified by pack-years.
Compared to the national trend, a significantly smaller percentage of plastic surgical patients were smokers (p = 0.01), with a less dramatic decline in prevalence. Smokers had significantly increased deep incisional surgical-site infections, incisional dehiscence, and reoperation (p < 0.01 for all). However, superficial surgical-site infection rates were not significantly different (p = 0.18). Smokers with 11 or more pack-years had significantly increased deep surgical-site infection (p < 0.01) and reoperations (p < 0.01). There were no significant differences in graft/prosthesis/flap loss (p = 0.07), bleeding (p = 0.40), sepsis (p = 0.87), or venous thromboembolism (p = 0.16) rates between smokers and nonsmokers.
This is the first large-scale propensity score-matched database analysis isolating smoking as a risk factor for postoperative complications in plastic surgical procedures. Smoking was an independent risk factor for deep incisional surgical-site infection, incisional dehiscence, and reoperation. Interestingly, superficial surgical-site infection rates were not significantly different. The authors recommend continued judicious patient selection and preoperative smoking counseling to optimize postoperative outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
吸烟与包括整形外科在内的多个专业的伤口愈合并发症及总体发病率相关。2005年至2014年期间，美国成年人的吸烟率从20.9%降至16.8%。本研究旨在调查整形外科患者的吸烟率是否与全国趋势一致，以及吸烟是否为术后并发症的独立危险因素。
使用2005年至2014年美国外科医师学会国家外科质量改进计划数据库，研究36454例行广泛解剖平面的常见整形手术患者的吸烟率及术后30天并发症情况。患者按人口统计学和合并症进行倾向得分匹配。吸烟者按吸烟包年数分层。
与全国趋势相比，整形外科患者中吸烟者的比例显著较小（p = 0.01），患病率下降幅度较小。吸烟者深部切口手术部位感染、切口裂开和再次手术的发生率显著增加（均p < 0.01）。然而，浅表手术部位感染率无显著差异（p = 0.18）。吸烟包年数为11年及以上的吸烟者深部手术部位感染（p < 0.01）和再次手术（p < 0.01）的发生率显著增加。吸烟者与非吸烟者在移植/假体/皮瓣丢失（p = 0.07）、出血（p = 0.40）、败血症（p = 0.87）或静脉血栓栓塞（p = 0.16）发生率方面无显著差异。
这是首次大规模倾向得分匹配数据库分析，将吸烟作为整形手术术后并发症的危险因素进行分离研究。吸烟是深部切口手术部位感染、切口裂开和再次手术的独立危险因素。有趣的是，浅表手术部位感染率无显著差异。作者建议继续审慎选择患者并进行术前吸烟咨询，以优化术后结果。
临床问题/证据水平：风险，II级
