General Complications after Endoscopic Sinus Surgery in Smokers: A 2005-2016 NSQIP Analysis

Abstract

Background: Exposure to cigarette smoke has been associated with a higher incidence of postoperative complications across a variety of surgical specialties. However, it is unclear if smoking increases this risk after endoscopic sinus surgery (ESS). Because complication rates after ESS are relatively low, a large national database allows for a statistically meaningful study of this topic. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2005 to 2016 was analyzed. Patients who underwent ESS were identified. Thirty-day postoperative complication rates between smokers and nonsmokers were compared. Complications included infection, thromboembolic events, reintubation, readmission, acute renal failure, and cardiovascular events. Results: 921 patients who underwent ESS were identified. 182 (20%) were smokers and 739 (80%) were nonsmokers. 609 patients underwent outpatient ESS, while 312 patients underwent inpatient ESS. A total of 12 patients experienced postoperative surgical site infections involving the deeper tissues beyond the wound (organ/space SSI). On univariate analysis, smoking was associated with a higher incidence of organ/space SSI ( P = .0067) and pulmonary embolism ( P = .0321) after ESS. On multivariate logistic regression, smoking was associated with increased odds (4.495, 1.11- 8.17, P = .0347) of organ/space SSI after ESS. Conclusions: This study demonstrates an association between exposure to cigarette smoke and potentially serious surgical site infections in the 30-day postoperative period after ESS. Our findings may help when counseling smokers who are considering ESS. Further study is required to understand the nature of these infections and ways to prevent them. Level of Evidence: 2c (“health outcomes”)

Racial Disparities in Tympanoplasty Surgery: A 30-Day Morbidity and Mortality National Cohort Study

“…Previous studies have also reported an increased risk of infection in Black compared with White patients in orthopedic surgery (26,27). We further corroborate a similar finding in tympanoplasty surgery noting that American Indian/Alaska Native patients were more likely to suffer from postoperative superficial SSIs (OR, 5.503) and Black patients of deep SSIs (OR, 6.292), even after adjusting for smoking, which has been linked to increased rates of infection (27–30). We again acknowledge that, although the overall ORs show a large disparity, the overall rate of these complications in this analysis was low, with 0.6 and 0.2% of patients experiencing superficial and deep SSIs, respectively (Table 2).…”

The Effect of Diabetes Mellitus on Post-Operative Outcomes in Patients Undergoing Endoscopic Sinus Surgery

“…16 Smoking, which can cause similar microvascular compromise, was also recently found to predispose ESS patients to surgical site infections. 19 However, despite what these studies may suggest a priori, we find no evidence of increased infectious burden for the diabetic patient. Given that reinfection after surgery has been shown to be a significant predictor of readmission risk, 7 these results are doubly reassuring.…”

Effect of Hypoalbuminemia in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

“…14,15 Numerous otolaryngologic studies have utilized the NSQIP to conduct retrospective analyses regarding surgical procedures. [16][17][18] This analysis includes only de-identified patient information that was deemed exempt from the Rutgers New Jersey Medical School Institutional Review Board, Newark, NJ, in accordance with their policy.…”