From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Am J Ophthalmol. 2023 May;249:174-182. doi: 10.1016/j.ajo.2023.01.020. Epub 2023 Jan 20.
To describe the association of smoking status with surgical intervention for thyroid eye disease (TED) at the population-level.
Retrospective cohort study.
This study included all adults (aged ≥18 years) with Graves disease in the Intelligent Research in Sight (IRIS) Registry (January 1, 2013, to December 31, 2020). The primary outcome was surgical intervention for TED, stratified into orbital decompression, strabismus surgery, and eyelid recession surgery. The Kaplan-Meier estimated 5-year cumulative probability for each surgical intervention was calculated. Multivariable Cox regression was used to evaluate the association between smoking status and each surgical intervention, adjusting for age, sex, race, ethnicity, and geographic region.
This study included 87,774 patients. Median age was 59 years (IQR, 48-68 years); 81% were female patients. Current smokers had a greater 5-year cumulative probability of orbital decompression (3.7% vs 1.9%; P < .001), strabismus surgery (4.6% vs 2.2%; P < .001), and eyelid recession (4.1% vs 2.6%; P < .001) compared to never smokers. After adjusting for demographic factors, current smokers were at greater risk for orbital decompression (hazard ratio [HR], 2.1; 95% CI, 1.8-2.4; P < .001), strabismus surgery (HR, 2.0; 95% CI, 1.8-2.3; P < .001), and eyelid recession (HR, 1.7; 95% CI, 1.5-1.9; P < .001) than never smokers. Former smokers were at higher risk for each type of surgery for TED, albeit at lower levels than current smokers.
Smoking was associated with increased risk of surgical intervention for TED in the IRIS Registry. Former smokers were at a lower risk than current smokers, supporting the role of smoking cessation on lowering the burden of surgical disease at the population-level.
描述人群中吸烟状况与甲状腺眼病（TED）手术干预的关系。
回顾性队列研究。
本研究纳入了 2013 年 1 月 1 日至 2020 年 12 月 31 日期间智能视力研究（IRIS）登记处所有年龄≥18 岁的格雷夫斯病成人患者。主要结局是 TED 的手术干预，分为眶减压、斜视手术和眼睑退缩手术。计算每种手术干预的 5 年累积概率的 Kaplan-Meier 估计值。多变量 Cox 回归用于评估吸烟状况与每种手术干预的关系，调整年龄、性别、种族、民族和地理位置。
本研究纳入了 87774 名患者。中位年龄为 59 岁（IQR，48-68 岁）；81%为女性患者。与从不吸烟者相比，当前吸烟者眶减压（3.7%比 1.9%；P<0.001）、斜视手术（4.6%比 2.2%；P<0.001）和眼睑退缩（4.1%比 2.6%；P<0.001）的 5 年累积概率更高。调整人口统计学因素后，与从不吸烟者相比，当前吸烟者眶减压（HR，2.1；95%CI，1.8-2.4；P<0.001）、斜视手术（HR，2.0；95%CI，1.8-2.3；P<0.001）和眼睑退缩（HR，1.7；95%CI，1.5-1.9；P<0.001）的风险更高。与从不吸烟者相比，曾经吸烟者 TED 手术的风险更高，但低于当前吸烟者。
吸烟与 IRIS 登记处 TED 手术干预风险增加相关。与当前吸烟者相比，曾经吸烟者的风险较低，这支持了戒烟在降低人群中手术疾病负担方面的作用。
