Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Prima Center for Plastic Surgery, Duluth, GA.
Aesthet Surg J. 2019 Jan 1;39(1):109-119. doi: 10.1093/asj/sjy088.
Smoking has been associated with several postoperative adverse outcomes across multiple surgical disciplines, but the literature is limited for aesthetic surgical procedures.
To compare complication rates between smokers and nonsmokers undergoing common cosmetic procedures, identify specific cosmetic procedures where smoking increases the risk of complications, and evaluate smoking as an independent risk factor for major complications following aesthetic surgery.
A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Smoking was evaluated as a risk factor for major complications requiring emergency room visit, hospital admission, or reoperation within 30 days after surgery. Multivariate regression analysis was performed controlling for the effects of age, gender, body mass index, type of surgical facility, type of procedure, and combined procedures.
Of the 129,007 patients, 10,621 (8.2%) were smokers. All procedures examined, except breast augmentation, were more frequently performed in the nonsmoker cohort. Overall major complications were similar between smokers and nonsmokers (2.0% vs 1.9%, P = 0.57). In univariate analysis, surgical site infections (0.6% vs 0.5%, P = 0.04) were significantly higher among smokers, but suspected venous thromboembolism (0.2% vs 0.1%, P = 0.01) was significantly higher among nonsmokers. Notably, smokers had a higher risk of major complications after body procedures (2.9% vs 1.0%, P = 0.01), as well as thigh lifts (23.8% vs 3.6%, P < 0.01) and male breast surgery (3.7% vs 1.4%, P = 0.03). In multivariate analysis, smoking was found to be an independent predictor of surgical site infections (relative risk 1.61, P < 0.01).
Smoking is an independent risk factor of major surgical site infections following aesthetic surgery. Body procedures, as well as thigh lifts and male breast surgery, have higher complication rates in smokers.
吸烟与多个外科领域的多种术后不良结果有关，但文献仅限于美容手术。
比较行常见美容手术的吸烟者和非吸烟者的并发症发生率，确定吸烟增加并发症风险的具体美容手术，并评估吸烟是否为美容手术后主要并发症的独立危险因素。
从 CosmetAssure 数据库中确定了 2008 年至 2013 年间接受美容手术的前瞻性队列患者。吸烟被评估为术后 30 天内需要急诊就诊、住院或再次手术的主要并发症的危险因素。多变量回归分析控制了年龄、性别、体重指数、手术设施类型、手术类型和联合手术的影响。
在 129007 名患者中，10621 名（8.2%）为吸烟者。除了隆胸术，所有检查的手术在非吸烟者队列中更为常见。吸烟者和非吸烟者的总体主要并发症相似（2.0%对 1.9%，P=0.57）。在单变量分析中，吸烟者的手术部位感染发生率（0.6%对 0.5%，P=0.04）明显较高，但非吸烟者的疑似静脉血栓栓塞症发生率（0.2%对 0.1%，P=0.01）明显较高。值得注意的是，吸烟者的主要并发症风险更高，尤其是在进行身体手术（2.9%对 1.0%，P=0.01）、大腿提升术（23.8%对 3.6%，P<0.01）和男性乳房手术（3.7%对 1.4%，P=0.03）后。多变量分析发现，吸烟是手术部位感染的独立预测因素（相对风险 1.61，P<0.01）。
吸烟是美容手术后主要手术部位感染的独立危险因素。身体手术、大腿提升术和男性乳房手术在吸烟者中的并发症发生率更高。
