Smokers Could Have an Increased Risk for Infection After Hip or Knee Surgery

According to a new study, smokers have an 80% increased risk of infectious (septic) complications following total hip or knee replacement surgery, requiring repeat surgery, compared to nonsmokers.

“Our results found that current smokers had a significantly higher rate of septic reoperation compared with nonsmokers,” comments Dr Matthew S. Austin of the Rothman Institute at Thomas Jefferson University, Philadelphia, senior author of the study, which was published recently in The Journal of Bone & Joint Surgery, published by Wolters Kluwer.

“Furthermore,” he adds, in a media release from Wolters Kluwer Health, “each additional pack-year significantly contributed to total reoperations.”

The study included data from 15,264 patients who underwent a total of 17,394 total joint replacements between 2000 and 2014—8,917 hip and 8,477 knee replacements.

At the time of surgery, 9% of the patients were current smokers, 34% were former smokers, and 57% were nonsmokers. Current smokers were younger than nonsmokers: average age was about 58 versus 63 years. Smokers also had higher rates of certain major respiratory and cardiovascular diseases.

The absolute risk of reoperation for infectious complications within 90 days was low: 0.71%. However, this risk was substantially higher for current smokers: 1.2%, compared to 0.56% for nonsmokers.

After adjustment for other characteristics, current smokers remained at significantly increased risk of reoperation for infectious complications—the relative risk was 80% higher, compared to nonsmokers. As a group, former smokers were not at increased risk, the release explains.

However, among both current and former smokers, smoking an extra pack a day for a decade was associated with a 12% increase in the relative risk for 90-day nonoperative readmission. Smoking overall, however, was unrelated to the risk of readmission without surgery, or for reoperation for reasons other than infections, the release continues.

“If smoking is associated with elevated perioperative risk of readmission and/or reoperation, then it may be reasonable to engage the patient in a smoking cessation program prior to total joint arthroplasty,” Austin and coauthors write, per the release.

They add, however, that further studies would be needed to determine whether quitting smoking before joint replacement surgery can reduce the risk of complications.

[Source(s): Wolters Kluwer Health, Science Daily]