Comparing the 30-Day Complications Between Smokers and Nonsmokers Undergoing Surgical Fixation of Ankle Fractures

Abstract

Background: There have been conflicting reports regarding the effect of smoking on complications after surgical treatment of ankle fractures. This study aimed at identifying the complications for which smokers and subgroups of smokers are at a higher risk compared to nonsmokers when undergoing surgery for fixation of rotational ankle fractures. Methods: The American College of Surgeons National Surgical Quality Improvement Program data set from 2008 to 2019 was used to compare the 30-day wound, cardiac, renal, and infectious complications, related readmissions, and return to the operating room between the 2 cohorts. Results: Of 33 741 patients included, 25 642 (76.0%) were nonsmokers and 8099 (24.0%) were smokers. Multivariate analysis showed that smokers were at a higher risk for deep wound infection (OR 2.34, 95% CI 1.48-3.69, P < .001), wound dehiscence (OR 2.43, 95% CI 1.56-3.77, P < .001), related return to the operating room (OR 1.69, 95% CI 1.36-2.11, P < .001), and related readmissions (OR 1.67, 95% CI 1.32-2.09, P < .001). Smokers at an increased risk for deep infection included patients between 50 and 59 years (OR 5.75, 95% CI 1.78-18.5, P = .003), who were Black (OR 4.24, 95% CI 1.04-17.23, P = .044), who had body mass index (BMI) 35 to 39.9 (OR 3.73, 95% CI 1.46-9.50, P = .006), or operative times between 60 and 90 minutes (OR 3.64, 95% CI 1.79-7.39, P < .001). Smoker subgroups at a higher risk for wound dehiscence included patients between 50 and 59 years (OR 9.86, 95% CI 3.29-29.53, P < .001), with operative times between 90 and 120 minutes (OR 4.88, 95% CI 1.89-12.58, P < .001), with BMI 30 to 34.9 (OR 3.06, 95% CI 1.45-6.45, P = .003) and who underwent spinal/epidural anesthesia (OR 9.31, 95% CI 2.31-37.58, P = .002). Conclusion: Smokers were at an increased risk for deep wound infection, wound dehiscence, related reoperations, and related readmissions after ankle fracture surgery. Certain subgroups were at an even higher risk for these complications. Level of Evidence: Level III, retrospective cohort study.

Adverse Events After Ankle Fracture Open Reduction Internal Fixation Among Patients With and Without Documented Cannabis and Tobacco Use

“…On multivariable analysis of the matched populations compared to nonusers, isolated tobacco users were (in decreasing order of ORs) at higher odds of UTI (OR 2.64), MAEs (OR 2.33), AAEs (OR 2.17), readmissions (OR 1.85), and SAEs (OR 1.84) in the 90 days postoperation ( P < .001 for all). These data are consistent with extensive literature regarding the correlation of tobacco use on perioperative adverse outcomes following ankle fracture ORIF 33 and supports the need to counsel patients about these associations in striving to optimize outcomes.…”

“…4,5,35 One such factor is tobacco/nicotine use, which is thought to affect angiogenesis at the fracture site, 6 promote osteoclast activity, 17 impair fracture healing in both in vitro and in vivo studies, 20,26,34,40 and impair wound healing. 36 Specific to ankle fracture ORIF, tobacco use has been associated with worse perioperative outcomes, 33 worse functional outcomes, 2 and increased postoperative pain scores. 2 Although the negative impact of tobacco use on perioperative outcomes following orthopaedic procedures is well described, it is not well established if cannabis has similar effects.…”

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

“…[40][41][42][43][44][45] Smoking has been associated with surgical site infections, postoperative wound complications, and reoperations after fracture fixation. [46][47][48] Bleeding disorders have been associated with increased risk of major postoperative complications and need for postoperative blood transfusion. 43,49 Dialysis dependency has been associated with greater risk of in-hospital mortality, longer postoperative stay, and reoperations.…”