Smoking is associated with increased surgical complications following total shoulder arthroplasty: an analysis of 14,465 patients

Althoff, Alyssa D.; Reeves, Russell A.; Traven, Sophia A.; Wilson, Joshua M.; Woolf, Shane K.; Slone, Harris S.

doi:10.1016/j.jse.2019.07.012

Cited by 36 publications

(19 citation statements)

References 25 publications

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“…While little correlation has been shown comparing age, gender, hypertension, and/or cardiac disease with postoperative infection, some studies have found a higher risk of postoperative infection in patients with higher body mass index, 18 diabetes, 14 and/or smoking history. 1 , 11 In our study, we did not identify an association with any medical comorbidity other than rheumatoid arthritis. Similarly, Cho et al 6 performed a systematic review of RTSA in patients with rheumatoid arthritis and described complications in nearly 1 in 5 patients.…”

Section: Discussioncontrasting

confidence: 65%

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Nezwek¹,

Dutcher²,

Mascarenhas³

et al. 2021

JSES International

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Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular surgery for patients with rotator cuff arthropathy, unreconstructible proximal humeral fracture, and end-stage glenohumeral arthritis. The increased annual volume of RTSAs has resulted in more postoperative complications and revision rates between 3.3% and 10.1%. Postoperative infection is one of the most common complications requiring revision surgery after primary RTSA. This study assesses patient-specific risk factors for development of early infection after primary RTSA in a single high-volume shoulder arthroplasty institution. Methods From 2014 to 2019, 902 consecutive primary RTSAs were performed for surgical treatment of rotator cuff arthropathy, glenohumeral arthritis, inflammatory arthropathy, and/or dislocation. Excluding proximal humeral or scapula fractures, 756 cases met the inclusion criteria and had a minimum of 3-month follow-up. All surgeries were performed using the same surgical technique and received similar antibiotic prophylaxis. Age, patient demographics, medical history, smoking history, and prior ipsilateral shoulder treatment and/or surgery were recorded. Multivariable logistic regression analysis was used to determine risk factors associated with development of postoperative shoulder infection. Results Thirty-five patients did not meet minimum follow-up criteria and were lost to follow-up. Overall, of 721, 22 patients (3%) developed a postoperative ipsilateral shoulder infection. Previous nonarthroplasty surgery and history of rheumatoid arthritis were significantly associated with the development of postoperative shoulder infection. Amongst 196 patients who had previous nonarthroplasty shoulder surgery, there were 12 postoperative shoulder infections (6%) compared with those without previous shoulder surgery (10 of 525, 2%) ( P = .003). Among 58 patients with rheumatoid arthritis, there were 5 postoperative shoulder infections (9%) compared with patients without rheumatoid arthritis (17 of 663, 3%) ( P = .010). Patient age, gender, smoking status, history of diabetes mellitus, history of cancer/immunosuppression, and prior cortisone injection did not demonstrate significant associations with the development of postoperative infection. Conclusion Prior nonarthroplasty shoulder surgery and/or rheumatoid arthritis are independently associated with the development of postoperative infection after primary RTSA. Patients who demonstrate these risk factors should be appropriately evaluated and preoperatively counseled before undergoing primary RTSA. Strong consideration should be given to avoid minimally invasive nonarthroplasty surgery as a temporizing measure to delay definitive RTSA.

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Section: Discussioncontrasting

confidence: 65%

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Nezwek¹,

Dutcher²,

Mascarenhas³

et al. 2021

JSES International

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“…3,18,26 However, when comparing the two existing national database studies, only Schwartz et al indicated tobacco usage as being an independent predictor of increased readmission rates, while Althoff et al did not report this distinction. 18,19 Due to this disagreement and the paucity in national analyses, it is important that further research is conducted. Using the most recent installment of NRD data, we provided an updated analysis on the impact tobacco usage has on short-term shoulder arthroplasty outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Pertinent complications that were analyzed were identified from previous literature on the topic. 18,19 Smoking was identified using ICD-10 codes: Z72.0 × (tobacco use disorder) and F17.2 × (nicotine dependence); this code has been utilized in literature as successful identifiers of patients who smoke. 25 Given the variability in smoking mechanisms, we elected to treat all patients who use tobacco and/or nicotine as "smokers."…”

Section: Methodsmentioning

confidence: 99%

“…18 Similarly, Althoff et al showed that smoking tobacco was associated with younger age at the time of surgery and increased risks for surgical complications in an analysis of 14,465 patients. 19 However, these national analyses differed in their conclusion for postoperative medical complications. Furthermore, in the limited literature, only a single study has analyzed the impact of smoking on short-term outcomes at the national level as it pertains to hemiarthroplasty procedures, where it was shown that smoking increases the odds for early revision.…”

Section: Introductionmentioning

confidence: 99%

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Impact of tobacco usage on readmission and complication rates following shoulder replacement surgery: A study of 164,527 patients

et al. 2022

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Background Tobacco carcinogens have adverse effects on bone health and are associated with inferior outcomes following orthopedic procedures. The purpose of this study was to assess the impact tobacco use has on readmission and complication rates following shoulder arthroplasty. Methods The 2016–2018 National Readmissions Database was queried to identify patients who underwent anatomical, reverse, and hemi-shoulder arthroplasty. ICD-10 codes Z72.0 × (tobacco use disorder) and F17.2 × (nicotine dependence) were used to define “tobacco-users.” Demographic, 30-/90-day readmission, surgical complication, and medical complication data were collected. Inferential statistics were used to analyze complications for both the cohort as a whole and for each procedure separately (i.e. anatomical, reverse, and hemiarthroplasty). Results 164,527 patients were identified (92% nontobacco users). Tobacco users necessitated replacement seven years sooner than nonusers ( p < 0.01) and were more likely to be male (52% vs. 43%; p < 0.01). Univariate analysis showed that tobacco users had higher rates of readmission, revisions, shoulder complications, and medical complications overall. In the multivariate analysis for the entire cohort, readmission, revision, and complication rates did not differ based on tobacco usage; however, smokers who underwent reverse shoulder arthroplasty in particular were found to have higher 90-day readmission, dislocation, and prosthetic complication rates compared to nonsmokers. Conclusion Comparatively, tobacco users required surgical correction earlier in life and had higher rates of readmission, revision, and complications in the short term following their shoulder replacement. However, when controlling for tobacco usage as an independent predictor of adverse outcomes, these aforementioned findings were lost for the cohort as a whole. Overall, these findings indicate that shoulder replacement in general is a viable treatment option regardless of patient tobacco usage at short-term follow-up, but this conclusion may vary depending on the replacement type used.

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“…Poor blood supply and necrosis are commonly linked to infection. There have been many general studies showing increased risk of infection and perioperative complications in patients who are smokers (55,56). One large meta-analysis revealed a surgical site infection odds ratio of 1.79 in smokers versus non-smokers as well as reduced infection (odds ratio 0.43) in patients who stopped smoking at least 4 weeks before their operation (57).…”

Section: Substance Use/abusementioning

confidence: 99%

Penile implant infection factors: a contemporary narrative review of literature

2021

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We aim to review and summarize published literature that features implanted penile devices and details infection of these devices as a complication. In particular, we will detail the factors that influence infection of penile implants.Background: Types of penile prostheses include inflatable implants and semirigid implants; these are utilized for treatment of erectile dysfunction. Likely the most feared complication of penile implants is infection. There are a handful of factors that are implicated in device infection.Methods: Searches were performed using MEDLINE and PubMed databases using keywords and phrases 'penile implant AND infection'; 'penile prosthesis AND infection'; 'penile implant infection'. We have presented results from our literature search. We divided these into 'Surgical Elements' and 'Patient Selection and Factors.' Each topic is discussed in its own section. Conclusions:Strides have been made since the initial penile prosthesis surgeries to improve infection rates including diabetes control, antibiotic coating of devices, and antibiotic implementation. Going forward, more studies, especially randomized control trials, need to focus on defining levels of diabetic control (sugar control and A1C control), determining the role of metabolic syndrome in infection promotion and determining laboratory values which could be predictive of infection. We present a discussion of important factors to consider in the realm of penile prosthesis infections. In addition, we include studies which discuss topics for future directions in decreasing the number of infections seen with penile prostheses.

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Smoking is associated with increased surgical complications following total shoulder arthroplasty: an analysis of 14,465 patients

Cited by 36 publications

References 25 publications

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Impact of tobacco usage on readmission and complication rates following shoulder replacement surgery: A study of 164,527 patients

Penile implant infection factors: a contemporary narrative review of literature

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