Validation of Self-Reported Smoking Status Among Orthopedic Hip Surgery Patients

Abstract

Purpose The purpose of this study was to determine the accuracy of self-reported non-smoking status in subjects undergoing elective orthopedic surgery as confirmed by serum cotinine levels. Methods Institutional Review Board approval was obtained for this retrospective review of consecutive subjects that underwent elective orthopedic surgery by a single fellowship-trained orthopedic surgeon. All patients provided smoking history (active, former, or non-smoker). Serum cotinine levels defined each subject as “non-smoker”, “passive tobacco exposure”, or “active smoker”. Self-reported non-smokers were eligible for inclusion. Subjects were excluded if they failed to provide smoking history, reported themselves as “smokers”, and/or had unavailable serum cotinine levels. Self-reported non-smoking status accuracy was determined by dividing the total number of included subjects by the number of subjects that were defined as “non-smoker” or “passive tobacco exposure” on their serum cotinine test. Results A total of 378 patients (mean age of 42.5 (13-78) years and 68% female) self-reported as non-smokers and were included. A total of 369 subjects had serum cotinine levels consistent with “non-smoking” resulting in a self-reported non-smoking status accuracy of 97.6%. None of the former smokers had cotinine levels consistent with active smoker status. Conclusion Subjects undergoing elective orthopedic surgery self-report as non-smokers with an accuracy of 97.6%. This suggests that routine serum cotinine testing of non-smokers in this patient population may not be necessary.

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

“…35 Cotinine testing may help improve both the identification of current smokers and the cessation of preoperative smoking. 26,36,37 There are several limitations to this study. Primarily, data were collected retrospectively from the ACS-NSQIP database which is not specific to orthopaedic surgery and some important arthroplasty-related complications, such as prosthetic joint infections, were not uniquely characterized.…”

“…35 Cotinine testing may help improve both the identification of current smokers and the cessation of preoperative smoking. 26 36 37…”

Smoking Cessation Initiatives in Total Joint Arthroplasty

“…Ellis et al found that self-reported smoking status in nonsmokers undergoing orthopaedic surgery was accurate >97% of the time when verified by serum cotinine levels 84 . Therefore, routine testing of nonsmokers prior to orthopaedic surgery may not be necessary.…”

“…It should be noted that neither CO nor cotinine testing has a long enough half-life to exclude the possibility of patients quitting only several days prior to testing 1 . Based on the current review of the literature, it appears that cotinine testing may provide some benefit for encouraging successful smoking cessation and validating self-reported smoking status [84][85][86] . However, further study is needed to determine the utility of other measures of smoking cessation prior to TJA.…”