These authors conducted a retrospective analysis of patients undergoing rotator cuff repair to examine the effects of smoking tobacco on patient-reported outcomes.
31 patients who smoked tobacco at the time of surgery were compared with 205 patients who were not smoking to determine if differences in (1) severity of preoperative and postoperative symptoms and (2) the postoperative improvements were statistically significant.
Preoperative scores were worse for smokers compared with nonsmokers: WORC (32 vs. 43; P ..0002), ASES (32 vs. 43; P ..001), SST (3.5 vs. 4.6; P ..04), and SANE (34 vs. 38; P ..35).
Postoperative scores were worse for smokers compared with nonsmokers: WORC (79 vs. 89; P ..001), ASES (82 vs. 89; P ..04), SST (9.0 vs. 10.2; P ..02), and SANE (84 vs. 89; P ..09).
There were no significant differences in change in scores over time or percentage of patients achieving the minimal clinically important difference of the score between groups.
Comment:
We know that patients can be "clinically improved" even though the surgical repair fails.
In the introduction the author state, "According to census data, approximately 15.5% (37.8 million people) of the US population smokes tobacco. Smoking has been associated with an increased incidence of rotator tears and severity of rotator cuff tears.Although smoking tobacco has been shown to have a detrimental influence on successful rotator cuff tendon healing after attempts at surgical repair, there are both insufficient and conflicting evidence regarding the relationship of smoking and clinical outcomes. It is universally recommended that patients cease smoking before rotator cuff repair surgery."
Comment:
We know that patients can be "clinically improved" even though the surgical repair fails.
In the introduction the author state, "According to census data, approximately 15.5% (37.8 million people) of the US population smokes tobacco. Smoking has been associated with an increased incidence of rotator tears and severity of rotator cuff tears.Although smoking tobacco has been shown to have a detrimental influence on successful rotator cuff tendon healing after attempts at surgical repair, there are both insufficient and conflicting evidence regarding the relationship of smoking and clinical outcomes. It is universally recommended that patients cease smoking before rotator cuff repair surgery."
Since the goal of cuff repair is to durably reattach the torn tendon(s) to the greater tuberosity, the question to be answered is "does smoking lead to an increased rate of repair failure". Unfortunately, followup MRI imaging of the repair was not obtained in this study, so the question was not answered.
Smoking has often been made to seem glamorous
Here's an interesting post, with this quote: "The fact that smoking is bad for people’s health has become common knowledge, yet a substantial amount of people still smoke. Previous studies that sought to better understand this phenomenon have found that smoking is associated with the tendency to take risk in other areas of life as well. The current paper explores factors that may underlie this tendency. An experimental analysis shows that smokers are more easily tempted by immediate high rewards compared to nonsmokers. Thus the salience of risky alternatives that produce large rewards most of the time can direct smokers to make bad choices even in an abstract situation such as the Iowa Gambling Task. These findings suggest that the risk taking behavior associated with smoking is not related to the mere pursuit of rewards but rather reflects a tendency to yield to immediate temptation."
Thus not only is the vascularity and healing potential at the repair site reduced by smoking, but smoking may also be associated with reduced compliance with postoperative restrictions.
Thus not only is the vascularity and healing potential at the repair site reduced by smoking, but smoking may also be associated with reduced compliance with postoperative restrictions.
Now here's a quiz. This paper comes from Virginia. Can you name the top five tobacco producing states in order? The answer can be found here.
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