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

Abstract

Background We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery. Methods A literature search was performed using the search terms “shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine].” Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges. Results Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly ( p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications. Discussion Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended. Level of Evidence Level III, Systematic Review.

The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery

“…While there are studies suggesting that smoking should be stopped at least eight weeks before operations to minimize postoperative complications 11 , 12 , Warner et al 13 reported that smokers who quit smoking six months before an operation would be similar to non-smokers in terms of postoperative complications. Zhao et al 14 found that preoperative smoking cessation at least three weeks before surgery led to better postoperative pain outcomes, whereas Kamma et al 15 showed that patients who quit smoking at least one month preoperatively had better pain scores than current smokers. Based on these findings, in the present study, those who had not smoked for six months prior to the tympanomastoidectomy were included in the group consisting of non-smokers (Group 2).…”

Smoking is an independent risk factor for complications in outpatient total shoulder arthroplasty

“…These findings reiterate the importance of preoperative smoking cessation and counseling for patients to reduce the likelihood of readmission following TSA, which has been demonstrated in prior literature. 17 , 22 , 30 , 40 …”