Agrawal Shubham, Ingrande Jerry, Said Engy T, Gabriel Rodney A
School of Medicine, University of California San Diego, San Diego, CA.
Department of Anesthesiology, University of California, San Diego, San Diego, CA.
J Arthroplasty. 2021 Mar;36(3):1029-1034. doi: 10.1016/j.arth.2020.09.049. Epub 2020 Oct 6.
Preoperative smoking is an easily modifiable risk factor and has associations with increased postoperative morbidity and mortality. It is important to clarify these risks for specific procedures to provide improved and evidence-based quality of care. The purpose of the present study aims to identify the associations between preoperative smoking and 30-day postoperative outcomes in patients undergoing total hip arthroplasty.
We used R statistics to conduct a multivariable logistic regression analysis followed by a propensity score matching analysis to explore the association between preoperative smoking and postoperative outcomes.
A final cohort of 67,897 patients who underwent total hip arthroplasty was selected for analysis. After adjusting for potential confounders, the odds of postoperative pulmonary complications (odds ratio [OR], 1.352; 95% confidence interval [95% CI], 1.075-1.700; P = .01), infectious complications (OR, 1.310; 95% CI, 1.094-1.567; P = .003), and extended hospital stay (OR, 1.17; 95% CI, 1.099-1.251; P < .001) were all significantly higher in the smoking population. After propensity matching these cohorts, both infectious complications (P = .017) and extended hospital stays (P = .001) were significantly higher in smoking patients.
After controlling for potential confounding variables, our multivariable regression analysis revealed a significant increase in pulmonary and infectious complications as well as significantly longer hospital stays in our smoking population. When using a propensity score matching analysis, an increase in infectious complications as well as extended hospital stay was observed. Given the concerning prevalence of smoking in the United States, our data provide updated information toward a growing mass of literature supporting smoking cessation before surgical operations.
术前吸烟是一个易于改变的风险因素，与术后发病率和死亡率增加相关。明确特定手术的这些风险对于提供更高质量且基于证据的医疗护理很重要。本研究的目的是确定接受全髋关节置换术患者术前吸烟与术后30天结局之间的关联。
我们使用R统计软件进行多变量逻辑回归分析，随后进行倾向评分匹配分析，以探讨术前吸烟与术后结局之间的关联。
最终选取67897例接受全髋关节置换术的患者组成队列进行分析。在调整潜在混杂因素后，吸烟人群术后肺部并发症（比值比[OR]，1.352；95%置信区间[95%CI]，1.075 - 1.700；P = 0.01）、感染性并发症（OR，1.310；95%CI，1.094 - 1.567；P = 0.003）以及延长住院时间（OR，1.17；95%CI，1.099 - 1.251；P < 0.001）的几率均显著更高。在对这些队列进行倾向匹配后，吸烟患者的感染性并发症（P = 0.017）和延长住院时间（P = 0.001）均显著更高。
在控制潜在混杂变量后，我们的多变量回归分析显示吸烟人群的肺部和感染性并发症显著增加，住院时间也显著延长。在使用倾向评分匹配分析时，观察到感染性并发症增加以及住院时间延长。鉴于美国吸烟的普遍程度令人担忧，我们的数据为越来越多支持手术前戒烟的文献提供了最新信息。
