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2014년 10월 23일 목요일

경추체 제거술 후의 수술결과와 위관절증에 대한 흡연의 영향 The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Brief review

JNS에서 10월호에 출판된 재밌는 논문 입니다.
결론부터 말하자면, 경추체 제거술 후의 수술결과와 합병증(pseudarthrosis)에 흡연여부가 유의하게 영햐을 미친다는 내용 입니다.

흡연여부에 따라 피험자를 비흡연자/ 끊은지 최소 1년이상된 자/ 흡연자  의 3그룹으로 나누었고, 이 피험자들의 30일이내 합병증 발병, 출혈량, 재원일수 등의 항목을 조사하였습니다.

결과적으로 흡연여부는 더 높은 합병증 발병률, 더 긴 재원일수에 영향을 미치는 risk factor로 밝혀졌으며, 감염 및 pseudarthrosis등의 합병증 발병에 특히 영향을 미친다고 합니다.
흡연의 해로움을 객관적 데이터로 보여준 논문입니다.


*Title: The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy.
경추체 제거술 후의 수술결과와 위관절증에 대한 흡연의 영향

*Authors: Lau D, Chou D, Ziewacz JE, Mummaneni PV


Object
Smoking is one of the leading causes of preventable morbidity and death in the US and has been associated with perioperative complications.
-To examined the effects of smoking on perioperative outcomes and pseudarthrosis rates following anterior cervical corpectomy.


Methods
Subjects: adult patients underwent anterior cervical corpectomy (2006~2011)
Grouping:
1) nonsmokers
2) quitters (quit for at least 1yr)
3) current smokers

Statistical analysis: using multivariate analysis
(To define the relationship between smoking and blood loss, 30-day complications, length of hospital stay, and pseudarthrosis)



















Results

Total 160 patients were included in the study.
(nonsmokers 49.4%, quitters 25.6%, current smokers 25.0%)
30-day complication rate: 20.0% (pseudarthrosis: 7.6%)
Mean blood loss: 368.3ml
Mean length of stay: 6.5days.

-Current smoking status was significantly associated with higher complication rates (p < 0.001) and longer lengths of stay (p < 0.001).
-Current smoking status remained an independent risk factor for both outcomes.
                                     
The complications that were experienced in current smokers were mostly infections (76.5%).
(Significantly greater than in nonsmokers and quitters (p = 0.013))
-Current smoking status was also an independent risk factor for pseudarthrosis at 1-year follow-up (p = 0.012).































Conclusions

Smoking is independently associated with higher perioperative complications (especially infectious complications), longer lengths of stay, and higher rates of pseudarthrosis in patients undergoing anterior cervical corpectomy.