Monday, November 7, 2016

Smoking increases the risk of shoulder arthroplasty complications.

These authors reviewed 1834 shoulders in 1614 patients (814 smokers and 1020 nonsmokers) having primary TSA or RSA at the Mayo Clinic between 2002 and 2011 and had a minimum 2-year follow-up. Smoking status was assessed at the time of surgery: non-smokers, former smokers (no smoking in the month before surgery), and current smokers (smoking within a month before surgery).

Complications occurred 4% of the cases, 5.4 % in smokers and 3.0 % in non smokers.

Multivariable analyses showed that
-in comparison to non-smokers, the risk of periprosthetic infection was 7.3 times higher in current smokers and 4.6 times higher in former smokers.
-in comparison to non-smokers, the risk of postoperative fracture was 7 times higher in current smokers.

The overall complication-free survival rate for the three groups is shown below.

Comment: It is of interest that 44% percent of the patients in this series were classified as smokers. It is also of interest that the risk of postoperative fracture was dramatically less in those that had stopped smoking a month or more prior to surgery, whereas the effect of smoking cession was less pronounced for the risk of infection.

Smoking has often been made to seem glamorous
but as we've presented in a prior post - Shoulder surgery and the Marlboro Man - it not only compromises health, but also is a marker for individuals that tend to put themselves at increased risk. 

The interested reader will also want to check out these two related posts:
Cigarette smoking affects bone, cuff repair, surgical risk and more
Pain and smoking

Our practice is to avoid shoulder arthroplasty in individuals with a recent history of smoking or other forms of nicotine use.


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