目标:由于血管手术的紧急性和紧急性,因此重点戒烟不如标准选择性手术,例如疝修补术。整容手术,和减肥程序。这项研究的目的是确定主动吸烟对接受外周血管干预(PVI)的患者的影响。我们的目标是确定在非紧急情况下,是否应通过诊所就诊而不是急诊室安排戒烟,是否应更加重视教育。
方法:本研究使用多机构去识别血管质量倡议-医疗保险链接数据库(VISION)进行。我们的研究包括2004-2019年间因外周动脉闭塞性疾病而接受PVI的索赔人。我们的最终样本包括18,726名患者:3,617(19.3%)不吸烟者(NS),9,975(53.3%)以前的吸烟者(FS)和5,134(27.4%)目前的吸烟者(CS)。我们对29个变量[年龄,性别,种族,种族,治疗设置(门诊或住院),肥胖,保险,高血压,糖尿病,CAD,CHF,COPD,CKD,上一个CABG,CEA,严重截肢,流入处理,先前的旁路或PVI,术前用药,治疗水平,伴随动脉内膜切除术,和治疗类型(粥样斑块切除术,血管成形术,支架)]在NS与FS之间以及FS与CS之间。结果是长期(五年)总生存期(OS),肢体抢救(LS),无再干预(FR)和无截肢生存(AFS)。
结果:PSM导致3,160对NS和FS匹配良好,3,750对FS和CS匹配良好。FS和NS在OS方面没有差异[HR=0.94,95%CI0.82-1.09,p=0.43],FR[HR=0.96,95%CI0.89-1.04,p=0.35],或AFS[HR=0.90,95%CI0.79-1.03,p=0.12]。然而,与CS相比,我们发现FS具有较高的OS[HR=1.18,95%CI1.04-1.33,p=0.01],较低的FR[HR=0.89,95%CI0.83-0.96,p=0.003]和较大的AFS[HR=1.16,95%CI1.03-1.31,p=0.01]。
结论:这项多机构医疗保险相关研究对出现跛行的PAD患者的选择性PVI病例进行了研究,发现前吸烟者与非吸烟者相比在OS方面具有相似的5年结局。FTR和AFS。此外,与以前吸烟者相比,目前吸烟者的总生存率和无截肢生存率较低.总的来说,这表明,应高度鼓励吸烟的人参加有组织的戒烟计划,甚至要求他们在选择性PVI之前停止吸烟,因为他们认为5年获益.
OBJECTIVE: Emphasis on tobacco cessation, given the urgent and emergent nature of vascular surgery, is less prevalent than standard elective cases such as hernia repairs, cosmetic surgery, and bariatric procedures. The goal of this study is to determine the effect of active smoking on claudicating individuals undergoing peripheral vascular interventions (PVIs). Our goal is to determine if a greater emphasis on education should be placed on smoking cessation in nonurgent cases scheduled through clinic visits and not the Emergency Department.
METHODS: This study was performed using the multi-institution de-identified Vascular Quality Initiative/Medicare-linked database (Vascular Implant Surveillance and Interventional Outcomes Network [VISION]). Claudicants who underwent PVI for peripheral arterial occlusive disease between 2004 and 2019 were included in our study. Our final sample consisted of a total of 18,726 patients: 3617 nonsmokers (19.3%) (NSs), 9975 former smokers (53.3%) (FSs), and 5134 current smokers (27.4%) (CSs). We performed propensity score matching on 29 variables (age, gender, race, ethnicity, treatment setting [outpatient or inpatient], obesity, insurance, hypertension, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, previous coronary artery bypass graft, carotid endarterectomy, major amputation, inflow treatment, prior bypass or PVI, preoperative medications, level of treatment, concomitant endarterectomy, and treatment type [atherectomy, angioplasty, stent]) between NS vs FS and FS vs CS. Outcomes were long-term (5-year) overall survival (OS), limb salvage (LS), freedom from reintervention (FR), and amputation-free survival (AFS).
RESULTS: Propensity score matching resulted in 3160 well-matched pairs of NS and FS and 3750 well-matched pairs of FS and CS. There was no difference between FS and NS in terms of OS (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.82-1.09; P = .43), FR (HR, 0.96; 95% CI, 0.89-1.04; P = .35), or AFS (HR, 0.90; 95% CI, 0.79-1.03; P = .12). However, when compared with CS, we found FS to have a higher OS (HR, 1.18; 95% CI, 1.04-1.33; P = .01), less FR (HR, 0.89; 95% CI, 0.83-0.96; P = .003), and greater AFS (HR, 1.16; 95% CI, 1.03-1.31; P = .01).
CONCLUSIONS: This multi-institutional Medicare-linked study looking at elective PVI cases in patients with peripheral artery disease presenting with claudication found that FSs have similar 5-year outcomes in comparison to NSs in terms of OS, FR, and AFS. Additionally, CSs have lower OS and AFS when compared with FSs. Overall, this suggests that smoking claudicants should be highly encouraged and referred to structured smoking cessation programs or even required to stop smoking prior to elective PVI due to the perceived 5-year benefit.