Assess the effect of smoking on post-operative complications following elective primary total hip replacement or primary total knee replacement (THR/TKR).
We used data from the national VA Surgical Quality Improvement Program (VASQIP) to examine the association of smoking status at surgery with 30-day post-operative complication rates (including surgical site and other infections, pneumonia, stroke, myocardial infarction, mortality, and other complications) in veterans undergoing primary elective THR or TKR. Multilevel multivariable-adjusted logistic regression models, adjusted for age, race/ethnicity, work RVU, ASA classification and year of surgery with additional adjustment for wound classification for surgical site infections, were used.
33,336 patients, 95% men and 80% Caucasian with mean age of 64 years underwent elective primary THR/TKR between October 2001 and September 2008. 57% never smoked, 19% were prior smokers and 24% current smokers. Current smokers undergoing THR/TKR were significantly more likely than never smokers to have surgical site infections (odds ratio [OR], 1.41; 95% CI, 1.16-1.72), pneumonia (OR, 1.53; 95% CI, 1.10-2.14), stroke (OR, 2.61; 95% CI, 1.26-5.41) and 1-year mortality (OR, 1.63; 95% CI, 1.31-2.02). Prior smokers were significantly more likely than non-smokers to have pneumonia, (OR, 1.34; 95% CI, 1.00-1.80), stroke (OR, 2.14; 95% CI, 1.26-5.41) and urinary tract infection (OR, 1.26; 95% CI, 1.02-1.55).
Current smoking at the time of elective THR or TKR is associated with increased post-arthroplasty complications, especially SSIs and pneumonia. Pre-operative smoking cessation programs should be considered in patients undergoing elective THR or TKR.