10.6084/m9.figshare.9211463.v1
Gulraj S Matharu
Gulraj S
Matharu
Sofia Mouchti
Sofia
Mouchti
Sarah Twigg
Sarah
Twigg
Antonella Delmestri
Antonella
Delmestri
David W Murray
David
W Murray
Andrew Judge
Andrew
Judge
Hemant G Pandit
Hemant G
Pandit
The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients
Taylor & Francis Group
2019
modifiable risk factor
LRTI
ex-smokers
patient-reported outcome measures
THR
1- year mortality rates
opioid usage 1- year postoperatively
HR
THA hazard ratio
TKA
population-based cohort study
PROM
postoperative outcomes
CI
smoking
non-smokers
RRR
knee arthroplasty
Hospital Episode Statistics
Clinical Practice Research Datalink
smoker
2019-08-02 08:36:02
Journal contribution
https://tandf.figshare.com/articles/journal_contribution/The_effect_of_smoking_on_outcomes_following_primary_total_hip_and_knee_arthroplasty_a_population-based_cohort_study_of_117_024_patients/9211463
<p>Background and purpose — Smoking is a modifiable risk factor that may adversely affect postoperative outcomes. Healthcare providers are increasingly denying smokers access to total hip and knee arthroplasty (THA and TKA) until they stop smoking. Evidence supporting this is unclear. We assessed the effect of smoking on outcomes following arthroplasty.</p> <p>Patients and methods — We identified THAs and TKAs from the Clinical Practice Research Datalink, which were linked with datasets from Hospital Episode Statistics and the Office for National Statistics to identify outcomes. The effect of smoking on postoperative outcomes (complications, medications, revision, mortality, patient-reported outcome measures [PROMs]) was assessed using adjusted regression models.</p> <p>Results — We studied 60,812 THAs and 56,212 TKAs (11% smokers, 33% ex-smokers, 57% non-smokers). Following THA, smokers had an increased risk of lower respiratory tract infection (LRTI) and myocardial infarction compared with non-smokers and ex-smokers. Following TKA, smokers had an increased risk of LRTI compared with non-smokers. Compared with non-smokers (THA relative risk ratio [RRR] = 0.65; 95% CI = 0.61–0.69; TKA RRR = 0.82; CI = 0.78–0.86) and ex-smokers (THR RRR = 0.90; CI = 0.84–0.95), smokers had increased opioid usage 1-year postoperatively. Similar patterns were observed for weak opioids, paracetamol, and gabapentinoids. 1-year mortality rates were higher in smokers compared with non-smokers (THA hazard ratio [HR] = 0.37, CI = 0.29–0.49; TKA HR = 0.52, CI = 0.34–0.81) and ex-smokers (THA HR = 0.53, CI = 0.40–0.70). Long-term revision rates were not increased in smokers. Smokers had improvement in PROMs compared with preoperatively, with no clinically important difference in postoperative PROMs between smokers, non-smokers, and ex-smokers.</p> <p>Interpretation — Smoking is associated with more medical complications, higher analgesia usage, and increased mortality following arthroplasty. Most adverse outcomes were reduced in ex-smokers, therefore smoking cessation should be encouraged before arthroplasty.</p>