Smoking Cessation Initiatives in Total Joint Arthroplasty

Abstract

As smoking increases the risk of adverse events and leads to increased hospital costs following total joint arthroplasty (TJA), many institutions have introduced perioperative smoking cessation initiatives. Although such programs have been demonstrated to improve outcomes for smokers undergoing TJA, the optimal approach, duration, and timing of smoking cessation models have not been well-defined.Overall, initiating a smoking cessation program 4 weeks preoperatively is likely adequate to provide clinically meaningful reductions in postoperative complications for smokers following TJA, although longer periods of cessation should be encouraged if feasible.Patients brought in for emergency surgical treatment who cannot participate in a preoperative intervention may still benefit from an intervention instituted in the immediate postoperative period.Cotinine testing may provide some benefit for encouraging successful smoking cessation and validating self-reported smoking status, although its utility is limited by its short half-life. Further study is needed to determine the value of other measures of cessation such as carbon monoxide breath testing.Smoking cessation programs instituted prior to TJA have been demonstrated to be cost-effective over both the short and long term.

Reasons and Risk Factors for Same-Day Discharge Following Total Joint Arthroplasty: A Systematic Review

“…Nevertheless, smoking is a modifiable risk factor that could be controlled [ 46 ]. Some studies recommend patients quit smoking at least 1 month before TJA to avoid postoperative complications [ 47 , 48 ].…”

Smoking cessation prior to total shoulder arthroplasty: A systematic review of outcomes and complications

“…A similar review investigating the potential benefits of smoking cessation prior to all types of total joint arthroplasty found results congruent to ours. 7 Although there are limited data regarding preoperative smoking cessation models and the quitting time required to yield improved postoperative outcomes, 33 information on preoperative smoking cessation models indicates that significant improvements in postoperative outcomes occur when patients stop smoking at least four weeks prior to surgery, and outcomes can be further improved with longer quit times. [34][35][36] Our findings specific to TSA parallel those of McConaghy et al 7 Based on the studies analyzed in our review, the clinical recommendation for a four-week minimum preoperative smoking cessation program prior to total joint arthroplasty is applicable for most patients prior to TSA.…”

“…7 Although there are limited data regarding preoperative smoking cessation models and the quitting time required to yield improved postoperative outcomes, 33 information on preoperative smoking cessation models indicates that significant improvements in postoperative outcomes occur when patients stop smoking at least four weeks prior to surgery, and outcomes can be further improved with longer quit times. [34][35][36] Our findings specific to TSA parallel those of McConaghy et al 7 Based on the studies analyzed in our review, the clinical recommendation for a four-week minimum preoperative smoking cessation program prior to total joint arthroplasty is applicable for most patients prior to TSA. Although benefits may be seen with as little as one month of smoking cessation, patients should be encouraged to abstain from smoking for as long as possible prior to TSA given the additional reductions in negative postoperative outcomes seen with longer quit times.…”

“…6 For total joint arthroplasty procedures, hospital costs are about $5000 higher for smoking patients than nonsmoking patients. 7 For surgical patients, smoking is the single most important risk factor for developing postoperative complications. 8 A randomized clinical trial found that a preoperative six-to eight-week smoking cessation program substantially reduced postoperative morbidity.…”

“…6 For total joint arthroplasty procedures, hospital costs are about $5000 higher for smoking patients than nonsmoking patients. 7…”