Abstract
Background
There is a paucity of literature evaluating the impact of smoking on revision arthroplasty
procedures. The purpose of this study was to identify the effect of smoking on complications
after revision total knee arthroplasty (rTKA).
Methods
We queried the American College of Surgeons National Surgical Quality Improvement
Program (NSQIP) database to identify patients who underwent rTKA between 2006 and
2014. Patients were divided into current smokers and nonsmokers according to the NSQIP
definitions. Each cohort was compared in terms of demographic data, preoperative comorbidities,
and operative time. Infection end points were created from composite surgical site
infection variables defined by the NSQIP database. Multivariate logistic regression
analysis was utilized to adjust for confounding variables and calculate adjusted odds
ratios (ORs) and associated 95% confidence intervals (95% CIs).
Results
In total, 8776 patients underwent rTKA. Of these patients, 11.6% were current smokers.
Univariate analyses demonstrated that smokers had a higher rate of any wound complication
(3.8% vs 1.8%, P < .0001), deep infection (2.5% vs 1.0%, P < .0001), pneumonia (1.3% vs 0.4%, P < .0001), and reoperation (5.0% vs 3.1%, P = .001) compared to nonsmokers undergoing revision total knee arthroplasty. Multivariate
analysis identified current smokers as being at a significantly increased risk of
any wound complication (OR 2.1; 95% CI 1.4-3.1) and deep infection (OR 2.1, 95% CI
1.2-3.6) after rTKA.
Conclusion
This study demonstrates that smoking significantly increases the risk of infection,
wound complications, and reoperation after rTKA. The results are even more magnified
for revision procedures compared to published effects of smoking on primary total
knee arthroplasty complications. Further research is needed regarding the impact of
smoking cessation on mitigation of these observed risks.
Keywords
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Article info
Publication history
Published online: March 17, 2018
Accepted:
March 12,
2018
Received in revised form:
February 26,
2018
Received:
December 1,
2017
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.03.024.
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