Doctors Should Help Patients Quit Smoking Before Orthopedic Surgery

Tobacco use is associated with several negative surgical outcomes, including impaired wound healing, increased infection, and poor lower joint replacement results.

Tobacco smokers who have orthopedic surgery face higher risks of complications and should be enrolled in smoking cessation programs, research shows.

A recent review of 26 scientific articles on smoking and orthopedic surgery found significant risk of negative outcomes for patients.

"People who smoke heavily before orthopedic surgery may have more nonmedical complications than nonsmokers. Therefore, all orthopedic surgery patients should be screened for tobacco use," wrote the author of the review in Hospital Practice, E. Carlos Rodriguez-Merchan MD, PhD.

Smoking cessation
 

Rodriguez-Merchan says surgeons should help patients stop smoking before and after orthopedic surgery.

"The adoption of smoking cessation methods such as transdermal patches, chewing gum, lozenges, inhalers, sprays, bupropion, and varenicline in the perioperative period should be recommended. Perioperative smoking cessation appears to be an efficacious method to decrease postoperative complications even if it is implemented as late as four weeks before surgery."

Research published last year examined an online smoking cessation program used by smokers undergoing orthopedic trauma surgery. The study showed both strengths and weaknesses of the cessation program.

The study featured 31 orthopedic trauma patients. Engagement in the online cessation program was high, with 28 of the patients using the program during their hospital admissions. In addition, 20 patients completed follow-up smoking cessation phone calls after discharge.

The patients reported several weaknesses of the online cessation program:

• Lack of time
   
• Desire for additional support
   
• Computer illiteracy or technology issues
   
• Feeling unprepared or too stressed to quit
   
• Reaching the point where nothing more could be learned from the online program

Smoking complications
 

Rodriguez-Merchan found multiple scientific articles that concluded smoking increases the risk of complications after orthopedic surgery.

"Orthopedic perioperative complications of smoking include impaired wound healing, augmented infection, delayed and/or impaired fracture union and arthrodesis, and worst total knee and hip arthroplasty results," he wrote.

• One fracture study found that a cessation protocol started in the inpatient setting and performed for six weeks decreased the risk of developing at least one postoperative complication. For the control group, 38% experienced at least one complication, compared to 20% of patients in the cessation protocol.
   
• Spine surgery research determined that smoking has a negative impact on surgical outcomes after lumbar and cervical spine procedures.
   
• A spinal fusion study showed smoking increases the rate of perioperative complications. Smoking cessation was recommended for four weeks following surgery.
   
• In anterior cruciate ligament surgery research, smoking was linked to increased rates of infection and venous thromboembolism after ACL reconstruction.