戒烟对足踝手术后愈合的影响。

Impact of smoking cessation on healing after foot and ankle surgery.

机构信息

Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.

出版信息

Orthop Traumatol Surg Res. 2022 Nov;108(7):103338. doi: 10.1016/j.otsr.2022.103338. Epub 2022 May 25.

DOI:10.1016/j.otsr.2022.103338

PMID:35643365

Abstract

INTRODUCTION

Perioperative smoking is the main risk factor for the development of postoperative cutaneous wound healing complications. We require that all patients undergoing elective foot and ankle surgery stop smoking (6 weeks before and 3 months after) and this abstinence is monitored with a preoperative cotinine test. We therefore wanted to understand how this impacted wound healing in elective foot and ankle surgery: do wounds heal differently in patients who quit smoking for surgery, former smokers and nonsmokers?

HYPOTHESIS

Our hypothesis was that patients who stopped smoking for an upcoming surgery had the same wound healing complications as nonsmokers and former smokers.

MATERIALS AND METHODS

This was a historical, single-center, single-surgeon cohort study of adult patients who underwent an elective ankle or foot surgery between June 2016 and July 2017. Patients were divided into 3 groups: group 1 smokers who stopped for surgery, group 2 former smokers, and group 3 nonsmokers. The primary endpoint was the occurrence of wound healing complications during the wound care consult scheduled 3 weeks after surgery.

RESULTS

A total of 256 patients with a mean age of 58±14.2 years (range, 18-88) were included. Group 3 had more women and a lower BMI than the other groups, but all the other demographic characteristics were similar. Smoking cessation was achieved in group 1 on average 2.5±1.3 months (range, 1-6) before surgery. There were a total of 20 wound healing complications or 7.5% of the cohort: 13% in group 1, 11.1% in group 2 and 6.4% in group 3. The univariate analysis found that the odds ratio was 2.3 when comparing Group 1 to Group 3 and 1.85 when comparing group 2 to group 3 (p=413). No significant risk factors for wound healing complications were found.

DISCUSSION/CONCLUSION: Smoking cessation for foot and ankle surgery seems to limit the risk of wound healing complications, with results close to those of former smokers and nonsmokers. Mandatory smoking cessation before surgery could be one of the solutions to prevent this frequent complication.

LEVEL OF EVIDENCE

III.

摘要

引言

围手术期吸烟是术后皮肤切口愈合并发症发展的主要危险因素。我们要求所有接受择期足踝手术的患者（术前 6 周至术后 3 个月）停止吸烟，并且通过术前可替宁检测来监测这种戒断情况。因此，我们想了解这对择期足踝手术中的伤口愈合有何影响：戒烟的患者、曾经吸烟的患者和不吸烟的患者的伤口愈合情况是否不同？

假设

我们的假设是，为手术而戒烟的患者与不吸烟的患者和曾经吸烟的患者的伤口愈合并发症相同。

材料和方法

这是一项回顾性、单中心、单外科医生队列研究，纳入了 2016 年 6 月至 2017 年 7 月间接受择期踝关节或足部手术的成年患者。患者分为 3 组：组 1 为为手术而戒烟的吸烟者，组 2 为曾经吸烟者，组 3 为不吸烟者。主要终点是术后 3 周预约伤口护理咨询时发生伤口愈合并发症的情况。

结果

共纳入 256 名平均年龄为 58±14.2 岁（范围 18-88 岁）的患者。组 3 的女性比例和 BMI 均高于其他组，但其他人口统计学特征相似。组 1 的平均戒烟时间为术前 2.5±1.3 个月（范围 1-6 个月）。共有 20 例伤口愈合并发症，占队列的 7.5%：组 1 为 13%，组 2 为 11.1%，组 3 为 6.4%。单因素分析发现，组 1 与组 3 相比，优势比为 2.3，组 2 与组 3 相比，优势比为 1.85（p=413）。未发现伤口愈合并发症的显著危险因素。

讨论/结论：为足踝手术而戒烟似乎可降低伤口愈合并发症的风险，结果接近曾经吸烟者和不吸烟者。术前强制戒烟可能是预防这种常见并发症的方法之一。