Abstract
Purpose
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.
Methods
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.
Results
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).
Conclusion
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.
Similar content being viewed by others
References
Alberg AJ, Worley ML, Tooze JA, Hatcher JL, Carpenter MJ, Day TA, Carpenter MJ, DSullivan CA, Warren GW, Sterba KR, Weaver KE (2015) The validity of self-reported recent smoking in head and neck cancer surgical patients. Otolaryngol Head Neck Surg 153:990–995
Argintar E, Triantafillou K, Delahay J, Wiesel B (2012) The musculoskeletal effects of perioperative smoking. J Am Acad Orthop Surg 20:359–363
Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM, Group LS (2005) Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma 19:151–157
Catalano JB, Iannacone WM, Marczyk S, Dalsey RM, Deutsch LS, Born CT et al (1995) Open fractures of the patella: long-term functional outcome. J Trauma 39:439–444
Clayton RAE, Court-Brown CM (2008) The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 39:1338–1344
Cole TJ (2015) Too many digits: the presentation of numerical data. Arch Dis Child 100(7):608–609
Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ (2015) The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Jt Surg Am 97:1049–1058
Garner MR, Gausden E, Berkes MB, Nguyen JT, Lorich DG (2015) Extensor mechanism injuries of the knee: demographic characteristics and comorbidities from a review of 726 patient records. J Bone Jt Surg Am 97:1592–1596
Greis PE, Holmstrom MC, Lahav A (2005) Surgical treatment options for patella tendon rupture, Part I: acute. Orthopedics 28:672–679 (quiz 671–680)
Grim C, Lorbach O, Engelhardt M (2010) Quadriceps and patellar tendon ruptures. Orthopade 39:1127–1134
Haas SB, Callaway H (1992) Disruptions of the extensor mechanism. Orthop Clin N Am 23:687–695
Haider AH, Bilimoria KY, Kibbe MR (2018) A checklist to elevate the science of surgical database research. JAMA Surg. https://doi.org/10.1001/jamasurg.2018.0628
Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F (1998) Less collagen production in smokers. Surgery 123:450–455
Lee D, Stinner D, Mir H (2013) Quadriceps and patellar tendon ruptures. J Knee Surg 26:301–308
Lee JJ, Patel R, Biermann JS, Dougherty PJ (2013) The musculoskeletal effects of cigarette smoking. J Bone Jt Surg Am 95:850–859
Lindstrom D, Sadr Azodi O, Wladis A, Tonnesen H, Linder S, Nasell H et al (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248:739–745
Myers K, Hajek P, Hinds C, McRobbie H (2011) Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis. Arch Intern Med 171:983–989
Nasell H, Ottosson C, Tornqvist H, Linde J, Ponzer S (2011) The impact of smoking on complications after operatively treated ankle fractures—a follow-up study of 906 patients. J Orthop Trauma 25:748–755
O’Malley M, Reardon P, Pareek A, Krych A, Levy BA, Stuart MJ (2016) Extensor mechanism disruption in knee dislocation. J Knee Surg 29:293–299
Porter SE, Hanley EN Jr (2001) The musculoskeletal effects of smoking. J Am Acad Orthop Surg 9:9–17
Roudet A, Boudissa M, Chaussard C, Rubens-Duval B, Saragaglia D (2015) Acute traumatic patellar tendon rupture: early and late results of surgical treatment of 38 cases. Orthop Traumatol Surg Res 101:307–311
Saragaglia D, Pison A, Rubens-Duval B (2013) Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement). Orthop Traumatol Surg Res 99:S67–S76
Sorensen LT, Jorgensen S, Petersen LJ, Hemmingsen U, Bulow J, Loft S et al (2009) Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res 152:224–230
Sorensen LT, Karlsmark T, Gottrup F (2003) Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 238:1–5
Tejwani NC, Lekic N, Bechtel C, Montero N, Egol KA (2012) Outcomes after knee joint extensor mechanism disruptions: is it better to fracture the patella or rupture the tendon? J Orthop Trauma 26:648–651
Tischler EH, Matsen Ko L, Chen AF, Maltenfort MG, Schroeder J, Austin MS (2017) Smoking increases the rate of reoperation for infection within 90 days after primary total joint arthroplasty. J Bone Jt Surg Am 99:295–304
Funding
There is no funding source.
Author information
Authors and Affiliations
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.
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Althoff, A.D., Reeves, R.A., Traven, S.A. et al. Smoking is associated with increased complications and readmission following extensor mechanism repair. Knee Surg Sports Traumatol Arthrosc 27, 3048–3053 (2019). https://doi.org/10.1007/s00167-018-5339-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-018-5339-y