Smokers More Likely to Develop Wound Complications After TJA

Yet another reason to quit smoking (or never start): Study data show smokers have a greater chance of developing wound complications following total hip or total knee arthroplasty. The results also indicate the greatest complication risk lies with current and former smokers who undergo the procedures.

University of Iowa investigators used the American College of Surgeons National Surgical Improvement Program database and identified 78,191 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2006 and 2012. A data abstracter collected morbidity and mortality data for the patients at 30 postoperative days.

Patients were grouped by smoking status as nonsmokers, current smokers or former smokers and categorized according to lifetime pack-years of smoking (0 pack-years, one to 20 pack-years, 21 to 40 pack-years or greater than 40 pack-years. The researchers used univariate and multivariate analyses to compare mortality rates, wound complications and total complications at 30 days.

Among the patients, of whom 81.8 percent were nonsmokers, 7.9 percent were former smokers and 10.3 percent were current smokers, results showed there was twice the rate of deep wound infections in the current smoker group versus the other groups. When former smokers were compared with current and nonsmokers, their risk of perioperative morbidity or mortality was higher.

Compared to nonsmokers, the multivariate analysis showed current smokers had a higher chance of wound complications than former smokers and nonsmokers (1.8 percent vs. 1.3 percent and 1.1 percent, respectively (P < 0.001) and the total complication risk for former smokers (6.9 percent) and current smokers (5.9 percent) exceeded that of nonsmokers (5.4 percent). No significant differences in complication risks, however, were seen between groups with regard to lifetime pack-years.