Smoking and Hypoalbuminemia as Risk Factors for Postoperative Complications in Reconstructive Hand and Forearm Surgery
Abstract
Introduction and Objective. At the present time, there is limited evidence regarding possible synergistic effects of smoking and hypoalbuminemia on postoperative complications following surgery of the hand and forearm. Our study aims to examine whether preoperative albumin levels modified the association between smoking status and post-operative complications following hand and forearm surgery in adults living in the US. Methods. We performed a retrospective cohort study using data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) participants. Forty-three CPT codes related to hand and forearm surgery from 2011-2021 were included. Smoking status within one year of surgery and preoperative albumin concentration below 3.5 g/dL were assessed as independent variables. Binary logistic regression models were used to estimate crude and adjusted associations. Results. A total of 20,725 patients were assessed. Overall, 21.1% had complications. Most frequent complications were length of hospital stay > 2 days and readmission ((17.9% and 2.6% of all complications, respectively). After adjusting, smokers had higher odds of postoperative complications when compared to nonsmokers (OR 1.16, 95% CI:1.04-1.29) and patients with hypoalbuminemia had 2.5 times higher odds of postoperative complications (OR 2.51, 95% CI: 2.25-2.80). We found no evidence of interaction effect between hypoalbuminemia and smoking status in the adjusted model (p-value for interaction term= 0.227). Conclusions-Implications. Our study suggests that smoking and hypoalbuminemia are independent risk factors increasing the risk of postoperative complications in patients undergoing hand and forearm procedures. Surgeons should consider smoking and hypoalbuminemia as potentially modifiable risk factors to reduce the risk of postoperative complications.
Keywords
hand surgery, complications, NSQIP, hypoalbuminemia
Presentation Type
Oral Presentation
Smoking and Hypoalbuminemia as Risk Factors for Postoperative Complications in Reconstructive Hand and Forearm Surgery
Introduction and Objective. At the present time, there is limited evidence regarding possible synergistic effects of smoking and hypoalbuminemia on postoperative complications following surgery of the hand and forearm. Our study aims to examine whether preoperative albumin levels modified the association between smoking status and post-operative complications following hand and forearm surgery in adults living in the US. Methods. We performed a retrospective cohort study using data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) participants. Forty-three CPT codes related to hand and forearm surgery from 2011-2021 were included. Smoking status within one year of surgery and preoperative albumin concentration below 3.5 g/dL were assessed as independent variables. Binary logistic regression models were used to estimate crude and adjusted associations. Results. A total of 20,725 patients were assessed. Overall, 21.1% had complications. Most frequent complications were length of hospital stay > 2 days and readmission ((17.9% and 2.6% of all complications, respectively). After adjusting, smokers had higher odds of postoperative complications when compared to nonsmokers (OR 1.16, 95% CI:1.04-1.29) and patients with hypoalbuminemia had 2.5 times higher odds of postoperative complications (OR 2.51, 95% CI: 2.25-2.80). We found no evidence of interaction effect between hypoalbuminemia and smoking status in the adjusted model (p-value for interaction term= 0.227). Conclusions-Implications. Our study suggests that smoking and hypoalbuminemia are independent risk factors increasing the risk of postoperative complications in patients undergoing hand and forearm procedures. Surgeons should consider smoking and hypoalbuminemia as potentially modifiable risk factors to reduce the risk of postoperative complications.