Division of Rhinology and Endoscopic Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA.
Department of Computer Science, Duke University, Durham, NC, USA.
Ann Otol Rhinol Laryngol. 2021 Apr;130(4):350-355. doi: 10.1177/0003489420952481. Epub 2020 Aug 20.
Exposure to cigarette smoke has been associated with a higher incidence of postoperative complications across a variety of surgical specialties. However, it is unclear if smoking increases this risk after endoscopic sinus surgery (ESS). Because complication rates after ESS are relatively low, a large national database allows for a statistically meaningful study of this topic.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2005 to 2016 was analyzed. Patients who underwent ESS were identified. Thirty-day postoperative complication rates between smokers and nonsmokers were compared. Complications included infection, thromboembolic events, reintubation, readmission, acute renal failure, and cardiovascular events.
921 patients who underwent ESS were identified. 182 (20%) were smokers and 739 (80%) were nonsmokers. 609 patients underwent outpatient ESS, while 312 patients underwent inpatient ESS. A total of 12 patients experienced postoperative surgical site infections involving the deeper tissues beyond the wound (organ/space SSI). On univariate analysis, smoking was associated with a higher incidence of organ/space SSI ( = .0067) and pulmonary embolism ( = .0321) after ESS. On multivariate logistic regression, smoking was associated with increased odds (4.495, 1.11- 8.17, = .0347) of organ/space SSI after ESS.
This study demonstrates an association between exposure to cigarette smoke and potentially serious surgical site infections in the 30-day postoperative period after ESS. Our findings may help when counseling smokers who are considering ESS. Further study is required to understand the nature of these infections and ways to prevent them.Level of Evidence: 2c ("health outcomes").
暴露于香烟烟雾与各种外科专业术后并发症的发生率增加有关。然而，尚不清楚吸烟是否会增加内镜鼻窦手术后（ESS）的风险。由于 ESS 后的并发症发生率相对较低，因此大型国家数据库可以对该主题进行具有统计学意义的研究。
分析了 2005 年至 2016 年美国外科医师学院国家外科质量改进计划（ACS-NSQIP）数据集。确定了接受 ESS 的患者。比较了吸烟者和非吸烟者之间 30 天术后并发症发生率。并发症包括感染，血栓栓塞事件，重新插管，再入院，急性肾衰竭和心血管事件。
共确定了 921 例接受 ESS 的患者。其中 182 例（20％）为吸烟者，739 例（80％）为非吸烟者。609 例患者接受了门诊 ESS，312 例患者接受了住院 ESS。共有 12 例患者发生了术后深层组织（器官/空间 SSI）的手术部位感染。单因素分析表明，吸烟与 ESS 后器官/空间 SSI（ = .0067）和肺栓塞（ = .0321）的发生率更高相关。多变量逻辑回归分析表明，吸烟与 ESS 后器官/空间 SSI 的几率增加相关（4.495，1.11-8.17， = .0347）。
本研究表明，在 ESS 后 30 天的术后期间，吸烟与潜在严重的手术部位感染之间存在关联。我们的发现可能有助于在为考虑 ESS 的吸烟者提供咨询时提供帮助。需要进一步的研究来了解这些感染的性质以及预防这些感染的方法。证据水平：2c（“健康结果”）。
