术前吸烟与术后肺部并发症发生的关系：一项对29个国家观察性研究的事后分析

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-05-14 DOI:10.1016/j.jclinane.2025.111856

Galina Dorland , W. Saadat , David M.P. van Meenen , Ary Serpa Neto , Michael Hiesmayr , Markus W. Hollmann , Gary H. Mills , Marcos F. Vidal Melo , Christian Putensen , Werner Schmid , Paolo Severgnini , Hermann Wrigge , Marcelo Gama de Abreu , Marcus J. Schultz , Sabrine N.T. Hemmes

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引用次数: 0

摘要

虽然吸烟一直被认为是术后并发症的一个重要因素，但现有文献关于其与术后肺部并发症的关系仍然存在矛盾。目的探讨术前吸烟与术后肺部并发症（PPCs）发生的关系。方法对29个国家146家医院的观察性研究进行事后分析。根据加泰罗尼亚手术患者呼吸风险评估（ARISCAT）评分（≥26分），我们纳入了PPCs风险增加的患者。主要终点是术后前5天内发生一次或多次预先确定的PPCs，包括术后意外需要补充氧气、呼吸衰竭、意外需要有创通气、ARDS、肺炎和气胸。次要终点包括住院时间和住院死亡率。我们进行倾向评分匹配，以纠正已知与术后结果相关的因素。结果2632例患者中吸烟531例（20.2%），不吸烟2102例（79.8%）。术后5天，吸烟者101例（19.0%）与非吸烟者404例（19.2%）发生了一种或多种PPCs （P = 0.95）。吸烟者（5.1%）比非吸烟者（3.0%）更常见呼吸衰竭（P = 0.02），而其他PPCs，如需要补充氧气、有创通气、ARDS、肺炎或气胸的发生率在两组之间没有差异。两组间住院时间和死亡率无显著差异。倾向评分匹配并没有改变研究结果。结论吸烟者与非吸烟者PPCs的发生无明显差异。这项分析是在没有额外资金的情况下进行的。LAS VEGAS由欧洲麻醉学会通过其临床试验网络和荷兰阿姆斯特丹的阿姆斯特丹大学医学中心部分资助和认可。注册号为拉斯维加斯，注册号为Clinicaltrials.gov （NCT01601223）。初步研究结果已在德国慕尼黑举行的2024年欧洲麻醉国际大会上发表。

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Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries

Introduction

While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting.

Aim

We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs).

Methods

Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes.

Results

Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings.

Conclusion

The occurrence of PPCs in smokers is not different from non–smokers.

Funding

This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands.

Registration

LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223).

Prior presentation

Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.