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Impact of smoking on outcomes following knee and shoulder arthroscopy

  • Original Article • KNEE - ARTHROSCOPY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study is to evaluate any association between preoperative smoking and perioperative and early postoperative complications in patients following shoulder and knee arthroscopic surgery.

Methods

This is a retrospective study using the prospectively collected National Surgery Quality Improvement Program database. All patients who underwent eight specific shoulder and knee arthroscopy procedures, identified by current procedural terminology codes, were included in this study and analyzed using univariate and multivariate analyses to determine the impact of preoperative smoking status on postoperative complications. These procedures were knee arthroscopy with meniscectomy (medial or lateral), knee arthroscopy with meniscectomy (medial and lateral), knee arthroscopy with chondroplasty, knee arthroscopy with anterior cruciate ligament reconstruction, shoulder arthroscopy with subacromial decompression, shoulder arthroscopy with debridement, subacromial arthroscopy with rotator cuff repair, and shoulder arthroscopy with distal clavicle excision. Thirty-day complications including cardiac, renal, wound, pulmonary, clotting, and mortality were assessed following knee and shoulder arthroscopy.

Results

A total of 134,822 cases were included in the study. Multivariate analysis found that smoking was an independent risk factor for complications in shoulder arthroscopy with subacromial decompression (odd’s ratio [OR] = 1.46; 95% confidence interval [CI] 1.030–2.075), shoulder arthroscopy with debridement (OR = 1.933; 95% CI 1.211–3.084), and knee arthroscopy with medial and lateral meniscectomy (OR = 1.97; 95% CI 1.407–2.757). Smoking was not an independent risk factor for complications in the other five procedures studied.

Conclusions

Preoperative smoking was found to be an independent risk factor for complications for several arthroscopic procedures, though with variability between specific procedures.

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References

  1. American College of Surgeons. User guide for the 2017 ACS NSQUP Participant Use Data File (PUF). https://www.facs.org/-/media/files/quality-programs/nsqip/nsqip_puf_userguide_2017.ashx?la=en. Accessed Sept 23, 2019

  2. Argintar E, Triantafillou K, Delahay J, Wiesel B (2012) The musculoskeletal effects of perioperative smoking. J Am Acad Orthop Surg 20(6):359–363

    Article  Google Scholar 

  3. Balain B, Kerin C, Kanes G, Roberts SN, Rees D, Kuiper JH (2012) Effects of knee compartment, concomitant surgery and smoking on medium-term outcome of microfracture. Knee 19(4):440–444

    Article  CAS  Google Scholar 

  4. Bedard NA, Dowdle SB, Owens JM, Duchman KR, Gao Y, Callaghan JJ (2018) What is the impact of smoking on revision total hip arthroplasty? J Arthroplasty 33(7S):S182–S185

    Article  Google Scholar 

  5. Blackwell R, Schmitt LC, Flanigan DC, Magnussen RA (2016) Smoking increases the risk of early meniscus repair failure. Knee Surg Sport Traumatol Arthrosc 24(5):1540–1543

    Article  Google Scholar 

  6. Brophy RH, Wright RW, Huston LJ, Nwosu SK, Spindler KP (2015) Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Jt Surg 97(6):450–454

    Article  Google Scholar 

  7. Cancienne JM, Gwathmey FW, Miller MD, Werner BC (2016) Tobacco use is associated with increased complications after anterior cruciate ligament reconstruction. Am J Sports Med 44(1):99–104

    Article  Google Scholar 

  8. Clement RC, Haddix KP, Creighton RA, Spang JT, Tennant JN, Kamath GV (2016) Risk factors for infection after knee arthroscopy: analysis of 595,083 cases from 3 United States databases. Arthrosc J Arthrosc Relat Surg 32(12):2556–2561

    Article  Google Scholar 

  9. de Valk EJ, Moen MH, Winters M, Bakker EWP, Tamminga R, van der Hoeven H (2013) Preoperative patient and injury factors of successful rehabilitation after anterior cruciate ligament reconstruction with single-bundle techniques. Arthroscopy 29(11):1879–1895

    Article  Google Scholar 

  10. 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(13):1049–1058

    Article  Google Scholar 

  11. Feng Y, Kong Y, Barnes PF, Huang FF, Klucar P et al (2011) Exposure to cigarette smoke inhibits the pulmonary T-cell response to influenza virus and Mycobacterium tuberculosis. Infect Immunol 79(1):229–237

    Article  CAS  Google Scholar 

  12. Friberger Pajalic K, Turkiewicz A, Englund M (2018) Update on the risks of complications after knee arthroscopy. BMC Musculoskelet Disord 19(1):1–7

    Article  Google Scholar 

  13. Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR (2000) The effect of cigarette smoking and smoking cessation on spinal fusion. Spine (Phila Pa 1976) 25(20):2608–2615

    Article  CAS  Google Scholar 

  14. Gullihorn L, Karpman R, Lippiello L (2005) Differential effects of nicotine and smoke condensate on bone cell metabolic activity. J Orthop Trauma 19(1):17–22

    Article  Google Scholar 

  15. Jamal A, Phillips E, Gentzke AS, Homa DM, Babb SD et al (2016) Current cigarette smoking among adults—United States. MMWR Morb Mortal Wkly Rep 67(2):53–59

    Article  Google Scholar 

  16. Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA (2014) The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 29(5):929–932

    Article  Google Scholar 

  17. Karim A, Pandit H, Murray J, Wandless F, Thomas NP (2006) Smoking and reconstruction of the anterior cruciate ligament. J Bone Jt Surg Br 88(8):1027–1031

    Article  CAS  Google Scholar 

  18. Kim S-J, Lee S-K, Kim S-H, Kim S-H, Ryu S-W, Jung M (2014) Effect of cigarette smoking on the clinical outcomes of ACL reconstruction. J Bone Jt Surg Am 96(12):1007–1013

    Article  Google Scholar 

  19. Martin CT, Gao Y, Pugely AJ, Wolf BR (2013) 30-day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases. J Shoulder Elb Surg 22(12):1667–1675.e1

    Article  Google Scholar 

  20. Moller AM, Villebro N, Pedersen T, Tonnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet (London, England) 359(9301):114–117

    Article  Google Scholar 

  21. Nåsell H, Ottosson C, Törnqvist H, Lindé JPS (2011) The impact of smoking on complications after operatively treated ankle fractures—a follow-up study of 906 patients. J Orthop Trauma 12:748–755

    Article  Google Scholar 

  22. Novikov DA, Swensen SJ, Buza JA 3rd, Gidumal RH, Strauss EJ (2016) The effect of smoking on ACL reconstruction: a systematic review. Phys Sportsmed 44(4):335–341

    Article  Google Scholar 

  23. Padmavathi P, Reddy VD, Maturu P, Varadacharyulu N (2010) Smoking-induced alterations in platelet membrane fluidity and Na(+)/K(+)-ATPase activity in chronic cigarette smokers. Atheroscler Thromb 17(6):619–627

    Article  CAS  Google Scholar 

  24. Purvis TE, Rodriguez HJ, Ahmed AK, Boone C, De la Garza-Ramos R et al (2017) Impact of smoking on postoperative complications after anterior cervical discectomy and fusion. J Clin Neurosci 38:106–110

    Article  Google Scholar 

  25. Raikin SM, Landsman JC, Alexander VA, Froimson MI, Plaxton NA (1998) Effect of nicotine on the rate and strength of long bone fracture healing. Clin Orthop Relat Res 353:231–237

    Article  Google Scholar 

  26. Santiago-Torres J, Flanigan DC, Butler RB, Bishop JY (2015) The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. Am J Sports Med 43(3):745–751

    Article  Google Scholar 

  27. Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J (2014) Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am 96(8):674–681

    Article  Google Scholar 

  28. Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I (2015) An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery. Arthroscopy 31(5):807–815

    Article  Google Scholar 

  29. Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M (2010) The effects of smoking on fracture healing. Surgeon 8(2):111–116

    Article  CAS  Google Scholar 

  30. Sorensen LT (2012) Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 255(6):1069–1079

    Article  Google Scholar 

  31. US Department of Health and Human Services. (2014) The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Heath and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health

  32. Villebro NM, Pedersen T, Moller AM, Tonnesen H (2008) Long-term effects of a preoperative smoking cessation programme. Clin Respir J 2(3):175–182

    Article  Google Scholar 

  33. Weber SC, Abrams JS, Nottage WM (2002) Complications associated with arthroscopic shoulder surgery. Arthroscopy 18(2 Suppl 1):88–95

    Article  Google Scholar 

  34. Westermann R, Anthony CA, Duchman KR, Gao Y, Pugely AJ et al (2017) Infection following anterior cruciate ligament reconstruction: an analysis of 6,389 cases. J Knee Surg 30(6):535–543

    Article  Google Scholar 

  35. Wong LS, Martins-Green M (2004) Firsthand cigarette smoke alters fibroblast migration and survival: implications for impaired healing. Wound Repair Regen 12(4):471–484

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M Street NW, 5th Floor, Washington, DC, 20037, USA

    Jessica H. Heyer, Dana A. Perim & Rajeev Pandarinath

  2. Department of Surgery, George Washington University Hospital, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA

    Richard L. Amdur

Authors
  1. Jessica H. Heyer
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  2. Dana A. Perim
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  3. Richard L. Amdur
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  4. Rajeev Pandarinath
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Correspondence to Jessica H. Heyer.

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Appendix

Appendix

See Table 6.

Table 6 Current procedural terminology (CPT) codes and abbreviations
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Heyer, J.H., Perim, D.A., Amdur, R.L. et al. Impact of smoking on outcomes following knee and shoulder arthroscopy. Eur J Orthop Surg Traumatol 30, 329–336 (2020). https://doi.org/10.1007/s00590-019-02577-2

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  • DOI: https://doi.org/10.1007/s00590-019-02577-2

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