Smoking is associated with increased complications and readmission following extensor mechanism repair

  • Alyssa D. AlthoffEmail author
  • Russell A. Reeves
  • Sophia A. Traven
  • Michael Byrd
  • Lee R. Leddy
  • Harris S. Slone



Extensor mechanism injuries are disabling injuries that require prompt evaluation and treatment and complications are often devastating. While smoking has been shown to increase complications following total joint arthroplasty, this relationship has not yet been established in those undergoing extensor mechanism repair. The purpose of this study was to evaluate the risk of smoking on postoperative complications following extensor mechanism repair.


The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent an extensor mechanism repair from 2005 to 2016. Patients were stratified by tobacco use, as either “current” or “nonsmokers.” A multivariate logistic regression was used to control for demographic and comorbid factors while assessing perioperative complications.


5208 patients were identified, and of these, 843 (16.2%) were current smokers. Smokers were younger, male, and with lower BMIs compared to nonsmokers (p = 0.001, p = 0.003, p = 0.002, respectively). They had a higher rate of surgical complications (OR 1.61, CI 1.02–2.52), including deep surgical site infections (OR 3.27, CI 1.03–10.43) and unplanned return to the operating room (OR 2.001, 1.24–3.23). Smokers were more likely to be readmitted within 30 days of surgery (OR 1.78, OR 1.09–2.90).


Tobacco use is associated with a 1–2% increase in surgical, but not medical, complications following repair of extensor mechanism injuries. Smokers are at higher risk for deep infections, unplanned return to the OR, and hospital readmission. Identifying these patients preoperatively will allow surgeons to accurately counsel patients on perioperative risks. Counseling in preoperative smoking cessation is valuable for optimizing patient outcomes following extensor mechanism repair.

Level of evidence

Retrospective comparative study, Level III.


Knee extensor mechanism Smoking Complications Outcomes Surgical repair 


Author contributions

AA, MB, and ST participated in data collection, manuscript writing, and coordination and organization of the research. RR participated in the design of the study and performed the statistical analysis, and participated in writing and revising the manuscript. HS and LL conceived the study and participated in its design and coordination of the manuscript. All authors read and approved the final manuscript.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.College of MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Orthopaedic SurgeryMedical University of South CarolinaCharlestonUSA

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