Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.
Department of Surgery, Rutgers New Jersey Medical School, Newark.
JAMA Facial Plast Surg. 2019 Jan 1;21(1):20-26. doi: 10.1001/jamafacial.2018.1176.
Smoking is a highly prevalent risk factor among patients with head and neck cancer. However, few studies have examined the association of this modifiable risk factor on postoperative outcomes following microvascular reconstruction of the head and neck.
To analyze the risk associated with smoking in patients undergoing free flap surgery of the head and neck.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, population, database study, the National Quality Improvement Program data sets from 2005 to 2014 were queried for all cases of head and neck surgery involving free flap reconstruction in the United States. The 2193 cases identified were stratified into smoking and nonsmoking cohorts and compared using χ2 and binary logistic regression analyses. Pack-years of smoking data were used to assess the degree of risk associated with a prolonged history of smoking. All analyses were conducted between January 2018 and June 2018.
Smoking and nonsmoking cohorts were compared for rates of demographic characteristics, comorbidities, and complications. Following correction for differences in patient demographics and comorbidities, smoking and nonsmoking cohorts were compared for rates of postoperative complications. Complication rates were further assessed within the smoking cohort by number of pack years smoked.
Of the 2193 patients identified as having undergone free flap reconstruction of the head and neck, 624 (28.5%) had a history of recent smoking. After accounting for differences in demographic variables and patient comorbidities using regression analyses, smoking status was found to be independently associated with wound disruption (odds ratio, 1.74; 95% CI, 1.17-2.59; P = .006) and unplanned reoperation (odds ratio, 1.50; 95% CI, 1.15-1.95; P = .003). An analysis by pack-years of smoking showed that a longer smoking history was significantly associated with higher rates of numerous comorbidities but not with a corresponding increase in rates of complications.
Smokers undergoing free flap reconstruction of the head and neck may be at significantly higher risk of postoperative wound disruption and subsequent reoperation. These risks were independent of pack-years of smoking history, suggesting that both risks were associated with perioperative smoke exposure, and preoperative smoking cessation may be of benefit.
NA.
吸烟是头颈部癌症患者的一个高度流行的风险因素。然而，很少有研究调查这种可改变的风险因素对头颈部微血管重建术后结果的影响。
分析吸烟对头颈部游离皮瓣手术患者相关风险。
设计、环境和参与者：在这项回顾性、人群、数据库研究中，在美国使用国家质量改进计划数据库 2005 年至 2014 年的数据，查询了所有涉及游离皮瓣重建的头颈部手术病例。确定了 2193 例病例，分为吸烟和不吸烟队列，并使用卡方检验和二元逻辑回归分析进行比较。吸烟年限数据用于评估与长期吸烟史相关的风险程度。所有分析均于 2018 年 1 月至 2018 年 6 月间进行。
比较吸烟和不吸烟队列的人口统计学特征、合并症和并发症发生率。在对患者人口统计学和合并症差异进行校正后，比较吸烟和不吸烟队列的术后并发症发生率。在吸烟队列中，进一步根据吸烟包年数评估并发症发生率。
在确定的 2193 例头颈部游离皮瓣重建患者中，有 624 例（28.5%）有近期吸烟史。在使用回归分析校正人口统计学变量和患者合并症差异后，吸烟状态与伤口破裂（比值比，1.74；95%CI，1.17-2.59；P=0.006）和计划外再次手术（比值比，1.50；95%CI，1.15-1.95；P=0.003）独立相关。吸烟包年数分析表明，吸烟史较长与多种合并症的发生率显著升高有关，但与并发症发生率的相应增加无关。
接受头颈部游离皮瓣重建的吸烟者术后伤口破裂和随后再次手术的风险可能显著增加。这些风险与吸烟包年数无关，表明两者的风险都与围手术期吸烟暴露有关，术前戒烟可能有益。
NA。
