Trends in the Prevalence and Postoperative Surgical Complications for Smokers Who Underwent a Total Knee Arthroplasty from 2011 to 2019: An Analysis of 406,553 Patients

Abstract

Smoking is a modifiable risk factor for complications following total knee arthroplasty (TKA). It is unclear if the declining prevalence of tobacco use in the U.S. population is reflected in patients undergoing elective TKA. This study aims to investigate (1) the incidence of 30-day complications following TKA in smokers and (2) trends in preoperative smoking status among TKA patients. In this study, patients undergoing primary elective TKA in the United States from 2011 to 2019 were identified in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database. Our cohort included 406,553 cases, 8.13% of which had smoked cigarettes within 1 year of undergoing TKA. Smokers were propensity score-matched to a group of nonsmokers, with each n = 32,533. The incidences of 30-day complications, readmission, and non-home discharge were compared between groups. The rate of preoperative smoking among elective primary TKA patients remained stagnant from 2011 to 2019. Smokers had higher rates of superficial surgical site infections (SSIs; 1.1 vs. 0.5%, p < 0.001), deep SSI (0.3 vs. 0.2%, p = 0.012), wound disruption (0.4 vs. 0.2%, p < 0.001), pneumonia (0.5 vs. 0.3%, p < 0.001), and 30-day readmission (3.6 vs. 2.7%, p < 0.001) compared with nonsmokers. No significant trends in 30-day complications were noted between 2011 and 2019. This study supports the success of national efforts to reduce the prevalence of smoking and reports a modest effect within the TKA population. However, almost 1 in 10 patients undergoing elective TKA continues to smoke and maintains a higher risk of postoperative complications.

Social Risk Determinants for Successful Same Calendar Day Discharge in Total Joint Arthroplasty

“…Surprisingly, our analysis suggested that successful SCDD patients were more likely to have a history of alcohol consumption and tobacco use. Although we found a positive association with successful SCDD, alcohol and tobacco use are typically considered risk factors for poorer health outcomes [18,19]. We speculate that healthier patients may consume more alcohol than less healthy patients, who may restrict alcohol intake for health concerns, but further study is needed on the underlying factors affecting the association of alcohol and tobacco use with successful SCDD in the context of TJA.…”