Li Renxi, Prastein Deyanira J, Boyce Steven W
The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, D.C., 20052, USA.
Department of Surgery, The George Washington University Hospital, Washington, D.C., USA.
J Artif Organs. 2025 May 26. doi: 10.1007/s10047-025-01515-w.
Left ventricular assist device (LVAD) implantation is a treatment option for advanced heart failure. The relationship between smoking and perioperative outcomes in LVAD implantation remains inconclusive, as evidence has been limited to single-center studies. This study aimed to examine the association between smoking and in-hospital outcomes of LVAD implantation in a large-scale population-based analysis. Patients who underwent LVAD implantation were selected from National Inpatient Sample from Q4 2015-2021. Multivariable logistic regression was used to compare in-hospital outcomes between smokers and non-smokers, where demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status were adjusted. There were 1346 (26.5%) smokers and 3737 (73.5%) non-smokers who underwent LVAD implantation. Smokers presented with a higher burden of comorbidities. After multivariable adjustment, smokers had lower in-hospital mortality (aOR 0.68, 95 CI 0.52-0.889, p < 0.01), MACE (aOR 0.74, 95 CI 0.554-0.987, p = 0.04), neurological complications (aOR 0.555, 95 CI 0.367-0.839, p = 0.01), stroke (aOR 0.508, 95 CI 0.311-0.832, p = 0.01), pericardial complications (aOR 0.705, 95 CI 0.545-0.913, p = 0.01), renal complications (aOR 0.691, 95 CI 0.595-0.801, p < 0.01), venous thromboembolism (aOR 0.523, 95 C = 0.295-0.929, p = 0.03), hemorrhage/hematoma (aOR 0.746, 95 CI 0.641-0.869, p < 0.01), and superficial wound complication (aOR 0.458, 95 CI 0.286-0.733, p < 0.01). Moreover, smokers had a shorter time from admission to operation (p = 0.02), shorter length of stay (p < 0.01), lower transfer out rate (p < 0.01), and lower hospital charge (p < 0.01). This study uncovered a "smoker's paradox" in LVAD implantation. These findings added to the long-standing observation of a "smoker's paradox" in cardiac surgery. However, the underlying reasons require further investigation.
左心室辅助装置（LVAD）植入是晚期心力衰竭的一种治疗选择。吸烟与LVAD植入围手术期结局之间的关系尚无定论，因为证据仅限于单中心研究。本研究旨在通过大规模基于人群的分析，探讨吸烟与LVAD植入住院结局之间的关联。2015年第四季度至2021年期间，从国家住院患者样本中选取接受LVAD植入的患者。采用多变量逻辑回归比较吸烟者和非吸烟者的住院结局，并对人口统计学、社会经济状况、主要支付者状况、医院特征、合并症以及转诊/入院状况进行了调整。共有1346名（26.5%）吸烟者和3737名（73.5%）非吸烟者接受了LVAD植入。吸烟者的合并症负担更高。多变量调整后，吸烟者的住院死亡率较低（调整后比值比[aOR]为0.68，95%置信区间[CI]为0.52-0.889，p<0.01）、主要不良心血管事件（aOR为0.74，95%CI为0.554-0.987，p=0.0）、神经系统并发症（aOR为0.555，95%CI为0.367-0.839，p=0.01）、中风（aOR为0.508，95%CI为0.311-0.832，p=0.01）、心包并发症（aOR为0.705，95%CI为0.545-0.913，p=0.01）、肾脏并发症（aOR为0.691，95%CI为0.595-0.801，p<0.01）、静脉血栓栓塞（aOR为0.523，95%CI为0.295-0.929，p=0.03）、出血/血肿（aOR为0.746，95%CI为0.641-0.869，p<0.01）和浅表伤口并发症（aOR为0.458，95%CI为0.286-0.733，p<0.01）。此外，吸烟者从入院到手术的时间更短（p=0.02）、住院时间更短（p<0.01）、转出率更低（p<0.01）且住院费用更低（p<0.01）。本研究发现了LVAD植入中的“吸烟者悖论”。这些发现进一步证实了心脏手术中长期存在的“吸烟者悖论”。然而，其潜在原因仍需进一步研究。
