Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada.
Departments of Medicine, Epidemiology, Biostatistics and Occupational Health, and Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.
Otolaryngol Head Neck Surg. 2020 Jan;162(1):108-113. doi: 10.1177/0194599819889622. Epub 2019 Nov 19.
To determine the effect of current smoking status on 30-day postoperative adverse events in patients undergoing otologic surgery.
Retrospective cohort study.
Database of the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2016.
Adult patients undergoing middle ear and mastoid surgery were included. Preoperative smoking status was determined, and adverse events within 30 days of surgery were recorded. Descriptive statistics were used to characterize the study sample. Multivariable logistic regression was performed to identify the association between sociodemographic and clinical variables and postoperative adverse events. Population-attributable fractions were then calculated.
A total of 10,684 patients who underwent otologic surgery were included, of whom 2036 (19.1%) were smokers. The most commonly performed surgery was tympanoplasty with and without ossicular chain reconstruction, followed by canal wall up tympanomastoidectomy. Adverse events occurred in 221 (2.1%) patients; the most common was superficial wound infections (n = 99, 0.9%). In smokers, the odds ratio for any adverse event was 1.97 (95% CI, 1.42-2.71). The odds ratios (95% CIs) for superficial wound infections, wound dehiscence, and 30-day readmission among smokers were 1.89 (1.32-2.86), 3.92 (1.26-11.60), and 1.84 (1.15-2.87), respectively. The population-attributable fraction for any adverse event in smokers was 15.5%.
In patients undergoing otologic surgery, smokers are more likely than nonsmokers to have postoperative adverse events-in particular, wound infections, wound dehiscence, and readmission to hospital.
确定当前吸烟状况对接受耳部手术患者术后 30 天不良事件的影响。
回顾性队列研究。
2006 年至 2016 年美国外科医师学会国家外科质量改进计划数据库。
纳入行中耳和乳突手术的成年患者。确定术前吸烟状况，并记录术后 30 天内的不良事件。采用描述性统计方法描述研究样本特征。采用多变量逻辑回归确定社会人口学和临床变量与术后不良事件之间的关联。然后计算人群归因分数。
共纳入 10684 例行耳部手术的患者，其中 2036 例（19.1%）为吸烟者。最常进行的手术是伴有或不伴有听骨链重建的鼓室成形术，其次是鼓室成形术伴乳突切开术。221 例（2.1%）患者发生不良事件；最常见的是浅表伤口感染（n=99，0.9%）。在吸烟者中，任何不良事件的比值比为 1.97（95%CI，1.42-2.71）。吸烟者发生浅表伤口感染、伤口裂开和 30 天内再入院的比值比（95%CI）分别为 1.89（1.32-2.86）、3.92（1.26-11.60）和 1.84（1.15-2.87）。吸烟者任何不良事件的人群归因分数为 15.5%。
在接受耳部手术的患者中，与不吸烟者相比，吸烟者更有可能发生术后不良事件，尤其是伤口感染、伤口裂开和再次入院。
