Sterling Joshua, Policastro Connor, Elyaguov Jason, Simhan Jay, Nikolavsky Dmitriy
SUNY Upstate Medical University, Department of Urology, Syracuse, NY, USA.
Yale School of Medicine, Department of Urology, New Haven, CT, USA.
Transl Androl Urol. 2023 Jan 30;12(1):112-127. doi: 10.21037/tau-22-427. Epub 2023 Jan 3.
The overall negative impact of tobacco use on an individual's health has been well documented but the literature on tobacco's impact on post-surgical outcomes, specifically the outcomes after urologic surgery, is not as clear cut. The aim of this narrative review is to provide urologists with the information needed to have a nuanced pre-operative counseling conversation with patients about tobacco use. Here we combine publications on the histologic and physiologic changes induced by nicotine and tobacco use with publications from the wider surgical literature on post-operative outcomes in tobacco users.
A literature search of PubMed, Google Scholar and Medline was performed using iterations of the following terms: tobacco, nicotine, changes, physiologic, histology, post-operative, and surgical. Non-English publications and abstracts were excluded. Inclusion required agreement from all authors and preference was given to human specimens over animal models for the basic science manuscripts and large database and meta-analyses over single institution experiences.
Tobacco use results in measurable changes in nearly every organ system in the body. While smokers have increased wound complications, there is no evidence that reconstructive surgery using grafts or flaps fail more frequently in tobacco users. Smokers have an increased risk of respiratory complications following endotracheal intubation.
Surgeries should not be canceled due to a patient's inability to cease tobacco use. Urologists and patients should engage in joint decision making regarding the timing and pursuit of elective operations.
烟草使用对个人健康的总体负面影响已有充分记录，但关于烟草对术后结局，特别是泌尿外科手术后结局的影响的文献并不那么明确。本叙述性综述的目的是为泌尿外科医生提供信息，以便在术前与患者就烟草使用进行细致入微的咨询谈话。在此，我们将关于尼古丁和烟草使用引起的组织学和生理学变化的出版物与更广泛的外科文献中关于烟草使用者术后结局的出版物相结合。
使用以下术语的迭代在PubMed、谷歌学术和Medline上进行文献检索：烟草、尼古丁、变化、生理学、组织学、术后和手术。排除非英文出版物和摘要。纳入要求所有作者一致同意，对于基础科学手稿，优先选择人类标本而非动物模型，对于大型数据库和荟萃分析优先于单机构经验。
烟草使用会导致身体几乎每个器官系统出现可测量的变化。虽然吸烟者的伤口并发症增加，但没有证据表明烟草使用者使用移植物或皮瓣进行的重建手术失败更频繁。吸烟者在气管插管后发生呼吸并发症的风险增加。
不应因患者无法戒烟而取消手术。泌尿外科医生和患者应就择期手术的时机和进行共同做出决策。
