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. 2015 Nov 19:13:283.
doi: 10.1186/s12916-015-0523-0.

Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study

Jasvinder A Singh  1   2   3 , Cathy Schleck  4 , W Scott Harmsen  4 , Adam K Jacob  5 , David O Warner  5 , David G Lewallen  6
Affiliations

Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study

Jasvinder A Singh et al. BMC Med. .

Abstract

Background: Tobacco smoking is a risk factor for several adverse post-operative outcomes. We aimed to compare the rates of complications in current tobacco users and non-users who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods: All patients who underwent primary THA or TKA at the Mayo Clinic from 2010-2013 were included in the study. Current tobacco use was defined as the use of cigarettes, cigars, pipes, or smokeless tobacco reported at the time of index THA or TKA; current non-users were former users or never users. We used Cox proportional hazards regression to assess the association of current tobacco use status with each post-THA/TKA complication, using hazard ratios and 95% confidence intervals (CI).

Results: Tobacco use status was available for 7926 patients (95%) and not available for 446 patients (5%); 565 (7%) were current tobacco users. Compared to non-users, current tobacco users were more likely to be male (p < 0.001), and less likely to be obese (p ≤ 0.008), be older than 60 years, have Charlson score >0 or have undergone TKA rather than THA (p < 0.001 each). The hazard ratios for deep infection (2.37; 95% CI 1.19, 4.72; p = 0.01) and implant revision (1.78; 95% CI 1.01, 3.13; p = 0.04) were higher in current tobacco users than in non-users. No significant differences were noted for periprosthetic fractures or superficial infections.

Conclusions: We noted that current tobacco use was associated with high risk of deep infection and implant revision after primary THA or TKA. Future studies should determine the optimal time for tobacco use cessation before elective surgeries such as THA and TKA to improve short-term and long-term arthroplasty outcomes.

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Figures

Fig. 1
Fig. 1
a Survival free of implant revision for any reason and b survival free of deep infection in current tobacco users (dashed line) compared with current tobacco non-users (solid line). CI confidence interval, HR hazard ratio
See this image and copyright information in PMC

References

    1. Sorensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069–79. doi: 10.1097/SLA.0b013e31824f632d. - DOI - PubMed
    1. Sorensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147(4):373–83. doi: 10.1001/archsurg.2012.5. - DOI - PubMed
    1. Singh JA, Houston TK, Ponce BA, Maddox G, Bishop MJ, Richman J, et al. Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res (Hoboken) 2011;63(10):1365–74. doi: 10.1002/acr.20555. - DOI - PubMed
    1. Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased revision rates after total knee arthroplasty in patients who smoke. J Arthroplasty. 2012;27(9):1690–5. doi: 10.1016/j.arth.2012.03.057. - DOI - PubMed
    1. Lubbeke A, Rothman KJ, Garavaglia G, Barea C, Christofilopoulos P, Stern R, et al. Strong association between smoking and the risk of revision in a cohort study of patients with metal-on-metal total hip arthroplasty. J Orthop Res. 2014;32(6):762–8. doi: 10.1002/jor.22603. - DOI - PubMed

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