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Smoking cessation and bone healing: optimal cessation timing

European Journal of Orthopaedic Surgery & Traumatology volume 25, pages 211–215 (2015)Cite this article

Abstract

Smoking is a worldwide epidemic. Complications related to smoking behavior generate an economic loss around $193 billion annually. In addition to impacting chronic health conditions, smoking is linked to increased perioperative complications in those with current or previous smoking history. Numerous studies have demonstrated more frequent surgical complications including higher rates of infection, poor wound healing, heightened pain complaints, and increased pulmonary morbidities in patients with a smoking history. Longer preoperative cessation periods also seem to correlate with reduced rates. At roughly 4 weeks of cessation prior to surgery, complication rates more closely reflect individuals without a smoking history in comparison with those that smoke within 4 weeks of surgery. In the musculoskeletal system, a similar trend has been observed in smokers with higher rates of fractures, nonunions, malunions, infections, osteomyelitis, and lower functional scores compared to non-smoking patients. Unfortunately, the present literature lacks robust data suggesting a temporal relationship between smoking cessation and bone healing. In our review, we analyze pseudoarthrosis rates following spinal fusion to suggest that bone healing in the context of smoking behavior follows a similar time sequence as observed in wound healing. We also discuss the implications for further clarity on bone healing and smoking cessation within orthopedics including improved risk stratification and better identification of circumstances where adjunct therapy is appropriate.

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Conflict of interest

The authors have no relevant financial relationships to disclose.

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Authors and Affiliations

  1. Department of Orthopaedics, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI, 02903, USA

    Jeremy Truntzer & Bryan Vopat

  2. Department of Orthopaedics, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA

    Michael Feldstein & Amir Matityahu

Authors
  1. Jeremy Truntzer
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  2. Bryan Vopat
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  3. Michael Feldstein
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  4. Amir Matityahu
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Correspondence to Jeremy Truntzer.

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Truntzer, J., Vopat, B., Feldstein, M. et al. Smoking cessation and bone healing: optimal cessation timing. Eur J Orthop Surg Traumatol 25, 211–215 (2015). https://doi.org/10.1007/s00590-014-1488-y

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  • DOI: https://doi.org/10.1007/s00590-014-1488-y

Keywords

  • Smoking cessation
  • Bone healing
  • Wound healing
  • Cigarettes