术前吸烟对男性择期胸科手术患者术后24h中重度疼痛的影响OA

Objective To investigate the effect of preoperative smoking on the occurrence of moderate-to-severe pain within 24 h after elective thoracic surgery in male patients,and to analyze the impact of smoking-related factors on postoper-ative pain.Methods A total of 426 male patients who underwent elective thoracic surgery from November 2024 to August 2025 were consecutively enrolled.According to the preoperative smoking status,patients were divided into the smoking group and non-smoking group(n=213 in each).Among smokers,patients were further categorized into the"current smok-ing"(n=107)and"current cessation"(n=106)based on whether preoperative smoking cessation lasted≥30 days.Moderate-to-severe pain was defined as a visual analogue scale(VAS)score≥4 at 24 h postoperatively.The incidence of moderate-to-severe pain,PACU stay duration,use of rescue analgesics within 24 h,length of hospital stay,and quality of recovery(QoR-15 score)were recorded and compared between groups.Univariate and multivariate Logistic regression ana-lyses were used to identify risk factors for moderate-to-severe pain.In smokers,smoking duration,daily cigarette consump-tion,Minnesota Nicotine Withdrawal Scale(MNWS)score,nicotine dependence(FTND),and smoking index were com-pared between current smoking and current cessation groups.We compared the mean values and 95%confidence intervals(95%CI)of the 24-hour postoperative VAS score and MNWS score among smoking patients with different preoperative smoking cessation durations(0 d,1-6 d,7-29 d,30-89 d,≥90 d).Univariate and multivariate Logistic regression analy-ses were used to explore the effects of smoking-related factors on the occurrence of moderate-to-severe pain within 24 h after thoracic surgery in male smokers.Results Among the 426 patients,145 cases(34.04%)experienced moderate-to-severe pain within 24 h after surgery,with a significantly higher incidence in the smoking group than in the non-smoking group(P<0.05).No significant differences were observed between the two groups in PACU stay,rescue analgesic use,or hospi-tal stay(all P>0.05),whereas the QoR-15 score was significantly lower in the smoking group(P<0.05).Multivariate Lo-gistic regression analysis showed that smoking history,higher preoperative PSQI score,and thoracotomy were independent risk factors for postoperative moderate-to-severe pain(all P<0.05),while age≥60 years and general anesthesia combined with nerve block were protective factors(all P<0.05).The incidence of moderate-to-severe pain was higher in the current smoking group than in the current cessation group(P<0.05).There were no significant differences in smoking duration,daily consumption,or nicotine dependence between the two groups(all P>0.05),but MNWS scores and smoking index were higher in the current smoking group(all P<0.05).Postoperative VAS scores showed an overall decreasing trend with increasing cessation duration,with the highest scores observed in the 1-6 d group and the lowest in the≥90 d group(P<0.05);some patients who had quit smoking≥30 d had VAS scores<4.MNWS scores were the lowest in patients with cessation≥90 d.Multivariate analysis further identified MNWS score and smoking index≥400 as independent risk fac-tors for moderate-to-severe pain(both P<0.05).Conclusions Preoperative smoking is associated with an increased risk of moderate-to-severe pain within 24 h after elective thoracic surgery in male patients.Among smokers,withdrawal symptoms and smoking index significantly influence postoperative pain risk.Preoperative smoking cessation for≥30 days may help re-duce the incidence of postoperative pain.Clinically,greater emphasis should be placed on preoperative smoking cessation and multimodal analgesia strategies to reduce early postoperative pain and improve recovery quality.