Effect of smoking and smoking cessation intervention on postoperative complications of orthopedic and hand surgery: A single-center interventional study.

Abstract

Introduction: Smoking impairs the outcome of surgery for many reasons. This study aimed to determine the effect of smoking, smoking cessation intervention, and other factors on the incidence of postoperative complications after elective orthopedic and hand surgery directed at bone or cartilage attached at the bone.

Methods: Altogether 451 patients, aged 18 years, participated in this single-center interventional study in Finland between 2015 and 2019. Their smoking status was confirmed by laboratory tests. The study's outcome was the occurrence, number, and severity of complications. A complication was defined as a prolonged hospital stay or any additional treatment or visit to a healthcare unit within 12 months, and its severity was determined by a modified Clavien-Dindo-Sink (CDS) index.

Results: Nine out of 80 smokers stopped smoking with laboratory verification before surgery, and additionally, six smokers stopped smoking at or after surgery. In comparison to never smokers, continuing smokers had more often at least one complication (adjusted odds ratio, AOR=2.50; 95% confidence interval, CI: 1.23-5.09; p<0.05) and more complications (adjusted risk ratio, ARR=1.58; 95% CI: 1.08-2.30; p<0.05). Further, the odds of being in a higher CDS-index category compared to the lower category (AOR=2.19; 95% CI: 1.14-4.19; p<0.05) also increased. With decreasing age, the occurrence (AOR = 0.98; 95% CI: 0.96-1.00; p<0.05) and number of complications (ARR=0.98; 95% CI: 0.97-1.00; p<0.01) decreased. Additionally, the odds of being in a higher CDS-index category compared to a lower category increased (AOR=0.98; 95% CI: 0.96-1.00; p<0.05). In comparison to men, women were more likely to have at least one complication (AOR=1.68; 95% CI: 1.03-2.75; p<0.05). With increasing alcohol consumption, the occurrence of at least one complication increased (AOR=1.10; 95% CI: 1.02-1.19; p<0.05).

Conclusions: Continuing to smoke and decreasing age, the occurrence, number, and severity of complications increased. Alcohol consumption and female sex were linked to an elevated occurrence of complications. It is important to wean every smoking patient, especially young smokers, from smoking to reduce the occurrence and severity of complications.