Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty

Tischler, Eric H.; Ko, Laura Matsen; Chen, Antonia F.; Maltenfort, Mitchell; Schroeder, J.H.; Austin, Matthew S.

doi:10.2106/jbjs.16.00311

Cited by 72 publications

(64 citation statements)

References 33 publications

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“…Similar to the present study, they also found that smokers had higher rate of multiple medical problems. 2 Our study found that smokers had an average increased inpatient cost of approximately $1100 per patient. It is also important to emphasize that this cost is only an approximation.…”

Section: Discussionmentioning

confidence: 58%

“…There are several factors that increase the rate of complications following total joint arthroplasty including but not limited to diabetes, obesity, alcohol consumption, and other medical comorbidities. 2,3 Smoking has emerged as another factor associated with high complication rates after total joint arthroplasty. 2,[4][5][6][7][8][9] It is estimated that 16.8% of adults smoked cigarettes in 2014 10 and up to 24% of total joint arthroplasty patients smoke.…”

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confidence: 99%

“…2,3 Smoking has emerged as another factor associated with high complication rates after total joint arthroplasty. 2,[4][5][6][7][8][9] It is estimated that 16.8% of adults smoked cigarettes in 2014 10 and up to 24% of total joint arthroplasty patients smoke. 4 Duchman et al found that current smokers have increased wound complications, and former and current smokers have an increased total complication risk following total joint arthroplasty.…”

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confidence: 99%

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Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

et al. 2020

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Given a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. There was a significant increase in the rate of smoking in TKA from 17.9% in 2012 to 19.2% in 2014 (p < 0.0001). The highest rate was seen in patients < 45 years of age (27.3%). Hospital resource usage was significantly higher for smokers, with a length of stay of 3.3 versus 2.9 days (p < 0.0001), and hospital costs of $16,752 versus $15,653 (p < 0.0001). A multivariable logistic model adjusting for age, gender, and comorbidities showed that smokers had an increased odds ratio for myocardial infarction (5.72), cardiac arrest (4.59), stroke (4.42), inpatient mortality (4.21), pneumonia (4.01), acute renal failure (2.95), deep vein thrombosis (2.74), urinary tract infection (2.43), transfusion (1.38) and sepsis (0.65) (all p < 0.0001). Smoking is common among patients undergoing elective TKA, and its prevalence continues to rise. Smoking is associated with higher hospital costs as well as higher rates of immediate inpatient complications. These findings are critical for risk stratification, improving of bundled payment models as well as patient education, and optimization prior to surgery to reduce costs and complications.

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Section: Discussionmentioning

confidence: 58%

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confidence: 99%

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confidence: 99%

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Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

et al. 2020

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“…Some of the variables that have been shown to affect the outcome after total joint replacement include social and demographic characteristics, medical comorbidities, and surgical technique [3][4][5][6][7]. Areas of continued active research include the effect of intrinsic factors such as obesity [8][9][10], cardiovascular disease [11,12], mental health disorders [13•, 14-17•, 18•, 19], hepatic disease [20, 21•, 22, 23•, 24], nutritional deficiencies [25-29•, 30], bone metabolic disease [31][32][33][34][35][36][37], and diabetes mellitus [38•, 39, 40], as well as external factors such as nicotine use [41,42], recent corticosteroid injections [43][44][45][46][47], and discharge disposition [48,49]. The goal of this article is to review the most recent literature, published within the last 3 years, regarding a selection of patient-specific factors that may influence This article is part of the Topical Collection on Quality and Cost Control in TJA outcomes following total joint arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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Purpose of Review It is well established that certain patientspecific risk factors affect outcomes following total joint arthroplasty. The goal of this paper is to summarize the latest data on several variables that have been investigated in the last 3 years and to characterize the effects these factors have on the success of hip and knee replacement. Recent Findings Preoperative diagnoses of depression and anxiety, liver disease, hypoalbuminemia, vitamin D deficiency, and diabetes mellitus are associated with increased risk of postoperative complications and can lead to worse outcomes after joint replacement surgery. Summary Recent investigations have clearly established a link between these patient-specific factors and poor outcomes after hip and knee arthroplasty, but future research is needed to determine best practices for stratifying and mitigating these risks for patients.

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“…2016, Tischler et al. 2017). However, these observations were not consistent between the different studies, with some studies reporting no effect of smoking on these same outcome measures (Inoue et al.…”

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confidence: 99%

The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients

et al. 2019

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Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 72 publications

References 33 publications

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients

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