Impact of Smoking Cessation Before Resection of Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Study
Impact of Smoking Cessation Before Resection of Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Study
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DOI：
10.1016/j.athoracsur.2009.04.035
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发表时间：
2009-08-01
影响因子：
4.6
通讯作者：
Blackstone, Eugene H.
中科院分区：
文献类型：
--
作者：
Mason, David P.;Subramanian, Sreekumar;Blackstone, Eugene H.
背景在肺癌切除术前戒烟被认为是有益的。戒烟对结果的影响进行了调查。从1999年1月至2007年7月，7990例成人肺癌初次切除术的院内结局报告给胸外科医师协会普通胸外科数据库。根据戒烟时间评估医院死亡和呼吸系统并发症的风险，并调整临床混淆因素。住院死亡率为1.4%（n = 109），但吸烟患者的死亡率为1.5%（105/6965），而非吸烟患者的死亡率为0.39%（4/1025）。与后者相比，风险调整的比值比分别为3.5（p = 0.03），4.6（p = 0.03），2.6（p = 0.7）和2.5（p = 0.11），戒烟时间分类为当前吸烟者，戒烟14天至1个月，1至12个月，或超过12个月术前。总体而言，主要肺部并发症的患病率为5.7%（456/7965），但吸烟患者的患病率为6.2%（429/6941），而非吸烟患者的患病率为2.5%（27/1024）。与后者相比，风险调整后的比值比分别为1.80（p = 0.03），1.62（p = 0.14），1.51（p = 0.20）和1.29（p = 0.3）的戒烟时间分类为上述。吸烟增加了肺癌切除术后住院死亡和肺部并发症的风险，并通过术前戒烟缓慢缓解。没有最佳的戒烟间隔是可识别的。无论手术时机如何，都应建议患者戒烟。
Background. Smoking cessation is presumed to be beneficial before resection of lung cancer. The effect of smoking cessation on outcome was investigated.Methods. From January 1999 to July 2007, in-hospital outcomes for 7990 primary resections for lung cancer in adults were reported to the Society of Thoracic Surgeons General Thoracic Surgery Database. Risk of hospital death and respiratory complications was assessed according to timing of smoking cessation, adjusted for clinical confounders.Results. Hospital mortality was 1.4% (n = 109), but 1.5% in patients who had smoked (105 of 6965) vs 0.39% in those who had not (4 of 1025). Compared with the latter, risk-adjusted odds ratios were 3.5 (p = 0.03), 4.6 (p = 0.03), 2.6 (p = 0.7), and 2.5 (p = 0.11) for those whose timing of smoking cessation was categorized as current smoker, quit from 14 days to 1 month, 1 to 12 months, or more than 12 months preoperatively, respectively. Prevalence of major pulmonary complications was 5.7% (456 of 7965) overall, but 6.2% in patients who had smoked (429 of 6941) vs 2.5%% in those who had not (27 of 1024). Compared with the latter, risk-adjusted odds ratios were 1.80 (p = 0.03), 1.62 (p = 0.14), 1.51 (p = 0.20), and 1.29 (p = 0.3) for those whose timing of smoking cessation was categorized as above.Conclusions. Risks of hospital death and pulmonary complications after lung cancer resection were increased by smoking and mitigated slowly by preoperative cessation. No optimal interval of smoking cessation was identifiable. Patients should be counseled to stop smoking irrespective of surgical timing.