非烟草尼古丁依赖与全膝关节置换术后并发症发生率：倾向评分匹配比较。
Non-Tobacco Nicotine Dependence and Rates of Postoperative Complications in Total Knee Arthroplasty: A Propensity-Matched Comparison.
机构信息
From the John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX (DeShazo, Crossnoe, Rogers), the Texas A&M School of Medicine, Health Professions Education Building, Bryan, TX (Bailey), and the Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX (Naeger).
出版信息
J Am Acad Orthop Surg. 2024 Nov 15;32(22):1032-1037. doi: 10.5435/JAAOS-D-23-01053. Epub 2024 May 2.
INTRODUCTION
Tobacco use elevates the incidence of postoperative complications and remains a key modifiable risk factor of perioperative surgical optimization. It remains unclear whether non-tobacco nicotine dependence confers an increased risk of surgical complications. This study evaluates postoperative complications in patients with non-tobacco nicotine dependence for total knee arthroplasty (TKA).
METHODS
We queried the TriNetX health database using Current Procedural Terminology and International Classification of Diseases, 10th Revision (ICD-10) codes and identified two cohorts for evaluation. Cohort A was defined as patients who had a TKA; had a dependence on nicotine; did not have nicotine dependence to cigarettes, chewing tobacco, other tobacco products; and were between the ages of 35 and 90 years. Cohort B was defined as patients who had a TKA but did not have a dependence on nicotine or a personal history of nicotine dependence and were between the ages of 35 and 90 years.
RESULTS
This study analyzed a total of 10,594 non-tobacco nicotine-dependent patients and 175,079 non-dependent patients who underwent TKA. In the analysis of propensity-matched cohorts, non-tobacco nicotine-dependent patients demonstrated an increased rate of various postoperative complications within 90 days. Dependent patients saw a significantly increased risk of infection after a procedure ( P < 0.001), deep vein thrombosis ( P < 0.001), pulmonary embolism ( P < 0.001), sepsis ( P = 0.0065), and prosthetic joint infection ( P = 0.0361) and a higher 3-year revision rate ( P = 0.0084).
DISCUSSION
Non-tobacco nicotine dependence demonstrated an increased associated risk of postoperative surgical complications for patients undergoing TKA. Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol.
LEVEL OF EVIDENCE
Level III, Prognostic.
简介
吸烟会增加术后并发症的发生率，仍然是围手术期外科优化的一个关键可改变的风险因素。目前尚不清楚非烟草尼古丁依赖是否会增加手术并发症的风险。本研究评估了接受全膝关节置换术（TKA）的非烟草尼古丁依赖患者的术后并发症。
方法
我们使用当前程序术语和国际疾病分类，第 10 版（ICD-10）代码在 TriNetX 健康数据库中进行了查询，并确定了两个队列进行评估。队列 A 定义为接受 TKA 的患者；有尼古丁依赖；没有对香烟、咀嚼烟草、其他烟草产品的尼古丁依赖；年龄在 35 岁至 90 岁之间。队列 B 定义为接受 TKA 但没有尼古丁依赖或尼古丁依赖病史且年龄在 35 岁至 90 岁之间的患者。
结果
本研究共分析了 10594 例非烟草尼古丁依赖患者和 175079 例非依赖患者接受 TKA。在倾向匹配队列的分析中，非烟草尼古丁依赖患者在 90 天内发生各种术后并发症的发生率增加。依赖患者在手术后发生感染的风险显著增加（P<0.001）、深静脉血栓形成（P<0.001）、肺栓塞（P<0.001）、败血症（P=0.0065）和人工关节感染（P=0.0361），以及 3 年翻修率较高（P=0.0084）。
讨论
非烟草尼古丁依赖患者在接受 TKA 时，术后手术并发症的风险增加。骨科医生应考虑在手术优化方案中评估非烟草尼古丁依赖。
证据水平
三级，预后。
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