Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI.
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
Ann Surg. 2023 Aug 1;278(2):201-207. doi: 10.1097/SLA.0000000000005735. Epub 2022 Oct 21.
To assess associations between co-occurring preoperative smoking and risky alcohol use on the likelihood of adverse surgical outcomes.
Risky alcohol use and smoking are the known surgical risk factors with a high co-occurrence and additive adverse effects on multiple organ systems that impact surgical health, yet no research has evaluated the impact of co-occurrence on surgical outcomes.
This investigation analyzed 200,816 patients from the Michigan Surgical Quality Collaborative database between July 1, 2012, to December 31, 2018. Patients were classified based on past year risky alcohol use (>2 drink/day) and cigarette smoking into 4 groups: (1) risky alcohol and smoking, (2) risky alcohol only, (3) smoking only, and (4) no risky alcohol/smoking. We fitted logistic regression models, applying propensity score weights incorporating demographic, clinical, and surgical factors to assess associations between alcohol and smoking and 30-day postoperative outcomes; surgical complications, readmission, reoperation, and emergency department (ED) visits.
Risky alcohol and smoking, risky alcohol only, and smoking only were reported by 2852 (1.4%), 2840 (1.4%), and 44,042 (22%) patients, respectively. Relative to all other groups, the alcohol and smoking group had greater odds of surgical complications, readmission, and reoperation. Relative to the no alcohol and smoking group, the alcohol only group higher odds of reoperation and smoking only group had higher odds of emergency department visits.
The combination of smoking and risky drinking conferred the highest likelihood of complications, readmission, and reoperation before surgery. Co-occurring alcohol and smoking at the time of surgery warrants special attention as a patient risk factor and deserves additional research.
评估术前同时存在吸烟和危险饮酒与不良手术结局发生的可能性之间的关联。
危险饮酒和吸烟是已知的手术风险因素，它们在多个器官系统中同时存在且具有相加的不良影响，从而影响手术健康，但尚无研究评估同时存在对手术结局的影响。
本研究分析了密歇根手术质量协作数据库 2012 年 7 月 1 日至 2018 年 12 月 31 日期间的 200816 例患者。患者根据过去一年的危险饮酒（>2 杯/天）和吸烟情况分为 4 组：（1）同时存在危险饮酒和吸烟，（2）仅存在危险饮酒，（3）仅存在吸烟，以及（4）不存在危险饮酒/吸烟。我们拟合了逻辑回归模型，应用倾向评分权重纳入人口统计学、临床和手术因素，以评估饮酒和吸烟与 30 天术后结局（手术并发症、再入院、再次手术和急诊就诊）之间的关联。
同时存在危险饮酒和吸烟、仅存在危险饮酒和仅存在吸烟的患者分别为 2852 例（1.4%）、2840 例（1.4%）和 44042 例（22%）。与所有其他组相比，同时存在饮酒和吸烟的组发生手术并发症、再入院和再次手术的可能性更高。与不存在饮酒和吸烟的组相比，仅存在饮酒的组再次手术的可能性更高，仅存在吸烟的组发生急诊就诊的可能性更高。
吸烟和危险饮酒同时存在时，术前发生并发症、再入院和再次手术的可能性最大。手术时同时存在酒精和吸烟应作为患者的风险因素引起特别关注，并值得进一步研究。
