Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
J Hand Surg Am. 2021 Apr;46(4):336.e1-336.e11. doi: 10.1016/j.jhsa.2020.07.014. Epub 2020 Aug 28.
Smoking is a prevalent modifiable risk factor that has been associated with adverse postoperative outcomes across numerous surgical specialties. We examined the impact of smoking on 30-day complications in patients undergoing hand surgery procedures.
The American College of Surgeons National Surgical Quality Improvement Program data sets were queried for patients who underwent common hand surgery procedures from 2011 to 2016. Cohorts were divided into smoking and nonsmoking and compared in terms of demographic characteristics, comorbidities, and postoperative complications. Multivariable logistic regression models were used to control for demographic characteristics and comorbidities in assessing the association between smoking and postoperative infections as well as other major and minor complications.
We identified a cohort of 48,370 patients in the National Surgical Quality Improvement Program who underwent certain outpatient and inpatient hospital facility-based hand surgery procedures from 2011 to 2016. Up to 22% of these patients reported active smoking. Compared with nonsmokers, smokers were more likely to be younger and male and to have a lower body mass index. In addition, they were more likely to have a higher American Society of Anesthesiologists classification and to report dyspnea and chronic obstructive pulmonary disease. Multivariable logistic regression identified an independent association between smoking and major complications. Smoking was not significantly associated with minor complications. When regrouped by complication type, smoking was associated with infectious and wound healing complications. In subgroup analysis, smokers undergoing elective hand surgery had increased odds of wound healing complications but not major, minor, or infectious complications.
Smokers may be at a significantly higher odds of certain complications compared with nonsmokers. For patients undergoing the elective procedures evaluated in this study, perioperative smoking may increase the risk of wound-healing complications.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
吸烟是一种普遍存在的可改变的风险因素，与许多外科专业的不良术后结果有关。我们研究了吸烟对手外科手术患者 30 天并发症的影响。
从 2011 年至 2016 年，我们在美国外科医师学会国家外科质量改进计划数据库中查询了接受常见手部手术的患者数据。将队列分为吸烟和非吸烟，并比较两组患者的人口统计学特征、合并症和术后并发症。多变量逻辑回归模型用于控制人口统计学特征和合并症，以评估吸烟与术后感染以及其他主要和次要并发症之间的关联。
我们从 2011 年至 2016 年在美国外科医师学会国家外科质量改进计划数据库中确定了一个接受特定门诊和住院医院手部手术的患者队列，共有 48370 例患者。这些患者中，高达 22%的患者报告正在吸烟。与非吸烟者相比，吸烟者更年轻、更男性化，体重指数更低。此外，他们更有可能具有较高的美国麻醉医师协会分类，并报告呼吸困难和慢性阻塞性肺疾病。多变量逻辑回归确定了吸烟与主要并发症之间的独立关联。吸烟与轻微并发症之间无显著相关性。当按并发症类型重新分组时，吸烟与感染和伤口愈合并发症有关。在亚组分析中，接受择期手部手术的吸烟者发生伤口愈合并发症的几率增加，但没有发生主要、次要或感染性并发症的几率增加。
与非吸烟者相比，吸烟者可能发生某些并发症的几率明显更高。对于接受本研究评估的择期手术的患者，围手术期吸烟可能会增加伤口愈合并发症的风险。
研究类型/证据水平：预后 II 级。
