Associations between smoking and clinical outcomes after total hip and knee arthroplasty: A systematic review and meta-analysis

Abstract

BackgroundSmoking increases risk of several complications after total hip or knee arthroplasty (THA/TKA), so we systematically reviewed and meta-analyzed the literature to take into account all relevant evidence, particularly studies published since 2010.MethodsThe PubMed, Ovid Embase, Web of Science, and EBSCOHost databases were searched and studies were selected and analyzed according to MOOSE recommendations. Methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Data were qualitatively synthesized or meta-analyzed using a random-effects model.ResultsA total of 40 studies involving 3,037,683 cases were included. Qualitative analysis suggested that smoking is associated with worse patient-reported outcomes within one year after surgery, and meta-analysis showed that smoking significantly increased risk of the following outcomes: total complications (OR 1.41, 95% CI 1.01–1.98), wound complications (OR 1.77, 95% CI 1.50–2.10), prosthetic joint infection (OR 1.84, 95% CI 1.52–2.24), aseptic loosening (OR 1.62, 95% CI 1.12–2.34), revision (OR 2.12, 95% CI 1.46–3.08), cardiac arrest (OR 4.90, 95% CI 2.26–10.60), cerebrovascular accident (OR 2.22, 95% CI 1.01–4.85), pneumonia (OR 2.35, 95% CI 1.17–4.74), acute renal insufficiency (OR 2.01, 95% CI 1.48–2.73), sepsis (OR 4.35, 95% CI 1.35–14.00), inpatient mortality (OR 12.37, 95% CI 4.46–34.28), and persistent opioid consumption (OR 1.64, 95% CI 1.39–1.92).ConclusionSmoking patients undergoing THA and TKA are at increased risk of numerous complications, inpatient mortality, persistent opioid consumption, and worse 1-year patient-reported outcomes. Pre-surgical protocols for these outcomes should give special consideration to smoking patients.

Tranexamic Acid Is Safe in Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty

“…The prevalence of patient comorbidities, the use of antithrombotics (aspirin, apixaban, dabigatran, dalteparin, fondaparinux, heparin, enoxaparin, rivaroxaban, and warfarin), and blood transfusion during admission were evaluated and compared between the high-risk cohorts who received TXA and who did not. Relevant preoperative comorbidities, such as myocardial infarction 15,[20][21][22] or cerebrovascular accident 15,20,22 , diagnosed peripheral vascular disease 27,28 or coronary artery disease 15,21 , presence of a coronary stent 15,21,22 , or active cigarette dependence [29][30][31][32][33][34] , were compared and reported. Medications were identified with the use of PHD-specific charge codes.…”

Effect of tobacco usage on surgical site wound problems after primary total hip and total knee arthroplasty: A meta‐analysis

“…Despite our efforts with the re‐defined analysis and using end points of both SSWP and any SSWP to produce a more accurate pooling of data, there was still heterogeneity in the definitions for infectious end points and tobacco use status for each included study. The outcome of the meta‐analyses was probably impacted by this 23–26 …”

“…The outcome of the meta-analyses was probably impacted by this. [23][24][25][26] The limitations of this meta-analysis are given next. There could be an assortment bias because some of the studies that were chosen for the meta-analysis were excluded.…”

Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review

“…These allow standardization of treatment goals and ensure that patients are discharged only when in a safe condition. Discharge criteria should be the following: stable ambulatory autonomy with crutch support and without dizziness; the absence of nausea or vomiting or a minimal presence that can be controlled without pharmacological intervention; pain <3 (according to the VAS scale) at rest and <5 during ambulation; and bleeding compatible with a normal postoperative course that does not require repeated dressing changes [ 37 , 38 ].…”

“…Smoking is a known risk factor associated with a high rate of perioperative and postoperative complications, like myocardial infarction, cardiac arrest, pneumonia, urinary tract infection, sepsis, acute renal failure, and mortality [ 37 , 38 , 39 ]. These complications result in a longer hospital stay and higher total hospital costs [ 39 ].…”