Increased Associated Risk of Surgical Site Infections in Trauma Patients Who Are Smokers

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-06-30 DOI:10.1016/j.jss.2025.05.024

Carlin Lee MD, Areg Grigorian MD, Raven Rutledge BS, Matthew Dolich MD, Michael E. Lekawa MD, Negaar Aryan MD, Cristobal Barrios MD, Jeffry Nahmias MD, MHPE

{"title":"Increased Associated Risk of Surgical Site Infections in Trauma Patients Who Are Smokers","authors":"Carlin Lee MD, Areg Grigorian MD, Raven Rutledge BS, Matthew Dolich MD, Michael E. Lekawa MD, Negaar Aryan MD, Cristobal Barrios MD, Jeffry Nahmias MD, MHPE","doi":"10.1016/j.jss.2025.05.024","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Smoking has been shown to increase the risk of surgical site infection (SSI) in elective surgery. This study aimed to determine the association between smoking and SSI in trauma patients (TPs), hypothesizing that TPs who are smokers have an increased associated risk of SSI compared to nonsmokers.</div></div><div><h3>Methods</h3><div>The Trauma Quality Improvement Program database (2017-2022) was queried for adults (age ≥ 18 y) undergoing any surgery related to trauma. Patients with length of stay < 48 h were excluded. The primary outcome was SSI. In addition to bivariate analyses, multivariable logistic regression analyses were performed to assess the associated risk of SSI in smokers <em>versus</em> nonsmokers, as well as planned subgroup analyses in patients with severe trauma (injury severity score (ISS) ≥16 and ≥ 25).</div></div><div><h3>Results</h3><div>Of 1,043,112 TPs, 254,017 (24.3%) were smokers. Compared to nonsmokers, smokers were younger (42 <em>versus</em> 53 y old, <em>P</em> < 0.001) and had higher rates of SSIs (0.9% <em>versus</em> 0.7%, <em>P</em> < 0.001). This was consistent in patients with ISS ≥16 (1.7% <em>versus</em> 1.4%, <em>P</em> < 0.001) and ISS ≥25 (2.0% <em>versus</em> 1.6%, <em>P</em> < 0.001). An increased associated risk for smokers persisted in multivariable analyses after controlling for age and steroid use in all patients (Odds ratio (OR) 1.15, 1.09-1.20 <em>P</em> < 0.001), as well as TPs with ISS ≥16 (OR 1.19, 1.12-1.26, <em>P</em> < 0.001) and ISS ≥25 (OR 1.19, 1.10-1.29, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Nearly a quarter of TPs were smokers, and these patients had an increased rate and associated risk of SSI. Interestingly, smoking was more strongly associated with SSI in patients suffering severe trauma. Given the urgent nature of trauma operations, patients should be counseled appropriately regarding their increased associated risk of SSI, and more research is required to determine if any preventative public health measures or perioperative interventions can mitigate the increased risk of SSI in this high-risk population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 221-226"},"PeriodicalIF":1.7000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480425003117","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Smoking has been shown to increase the risk of surgical site infection (SSI) in elective surgery. This study aimed to determine the association between smoking and SSI in trauma patients (TPs), hypothesizing that TPs who are smokers have an increased associated risk of SSI compared to nonsmokers.

Methods

The Trauma Quality Improvement Program database (2017-2022) was queried for adults (age ≥ 18 y) undergoing any surgery related to trauma. Patients with length of stay < 48 h were excluded. The primary outcome was SSI. In addition to bivariate analyses, multivariable logistic regression analyses were performed to assess the associated risk of SSI in smokers versus nonsmokers, as well as planned subgroup analyses in patients with severe trauma (injury severity score (ISS) ≥16 and ≥ 25).

Results

Of 1,043,112 TPs, 254,017 (24.3%) were smokers. Compared to nonsmokers, smokers were younger (42 versus 53 y old, P < 0.001) and had higher rates of SSIs (0.9% versus 0.7%, P < 0.001). This was consistent in patients with ISS ≥16 (1.7% versus 1.4%, P < 0.001) and ISS ≥25 (2.0% versus 1.6%, P < 0.001). An increased associated risk for smokers persisted in multivariable analyses after controlling for age and steroid use in all patients (Odds ratio (OR) 1.15, 1.09-1.20 P < 0.001), as well as TPs with ISS ≥16 (OR 1.19, 1.12-1.26, P < 0.001) and ISS ≥25 (OR 1.19, 1.10-1.29, P < 0.001).

Conclusions

Nearly a quarter of TPs were smokers, and these patients had an increased rate and associated risk of SSI. Interestingly, smoking was more strongly associated with SSI in patients suffering severe trauma. Given the urgent nature of trauma operations, patients should be counseled appropriately regarding their increased associated risk of SSI, and more research is required to determine if any preventative public health measures or perioperative interventions can mitigate the increased risk of SSI in this high-risk population.

查看原文本刊更多论文

吸烟创伤患者手术部位感染的相关风险增加

吸烟已被证明可增加择期手术手术部位感染（SSI）的风险。本研究旨在确定吸烟与创伤患者SSI之间的关系，假设吸烟的创伤患者与不吸烟的创伤患者相比，SSI的相关风险增加。方法查询创伤质量改善计划数据库（2017-2022）中接受任何创伤相关手术的成人（年龄≥18岁）。住院时间<；48 h被排除在外。主要结局为SSI。除了双变量分析外，还进行了多变量logistic回归分析，以评估吸烟者与非吸烟者发生SSI的相关风险，并对严重创伤患者（损伤严重程度评分(ISS)≥16和≥25）进行了计划的亚组分析。结果1043112名TPs中，吸烟254017人（24.3%）。与不吸烟者相比，吸烟者更年轻(42岁对53岁，P <；0.001)， ssi发生率较高(0.9%对0.7%,P <；0.001)。这在ISS≥16的患者中是一致的(1.7% vs 1.4%, P <；0.001), ISS≥25 (2.0% vs 1.6%, P <；0.001)。在控制了所有患者的年龄和类固醇使用后，多变量分析显示吸烟者的相关风险持续增加(优势比（OR） 1.15, 1.09-1.20 P <；0.001)，以及ISS≥16的TPs (OR 1.19, 1.12-1.26, P <；0.001), ISS≥25 (OR 1.19, 1.10-1.29, P <；0.001)。结论：近四分之一的TPs是吸烟者，这些患者的SSI发生率和相关风险增加。有趣的是，在遭受严重创伤的患者中，吸烟与SSI的关系更为密切。鉴于创伤手术的急迫性，应适当告知患者其相关的SSI风险增加，并且需要更多的研究来确定是否有任何预防性公共卫生措施或围手术期干预措施可以减轻这一高危人群中SSI增加的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.