Primary total elbow arthroplasty, is there a correlation between smoking and postoperative complications? A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Database

• Published in: Seminars in arthroplasty Vol. 34; no. 1; pp. 68 - 74
• Main Authors: Chenault, Parker K., Hendrix, Christopher G., Peterman, Nicholas J., Schmitt, Mark W., Beck, Jadon H., Hackley, Darren T., Vest, Maxwell O., Bravo, Cesar J.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-03-2024
• Subjects: Arthroplasty; Complications; Elbow; National Surgical Quality Improvement Program; Smoking; Total elbow arthroplasty; Complications; Arthroplasty; National Surgical Quality Improvement Program; Total elbow arthroplasty; Elbow; Retrospective Cohort Study; Level III; Smoking
• ISSN: 1045-4527; 1558-4437
• DOI: 10.1053/j.sart.2023.08.011

Smoking has been suggested to be correlated with increased rates of several postoperative complications following total joint arthroplasty. As the utilization of total elbow arthroplasty (TEA) continues to rise, identifying modifiable factors to best optimize the patient is crucial. The goal of this study is to identify if a correlation exists between smoking status and 30-day postoperative complications following TEA.
Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2021 using Current Procedural Terminology code 24363 (Arthroplasty, elbow, with distal humeral and proximal ulnar prosthetic replacement; total elbow). Patients were placed into 1 of 2 cohorts based on smoking status. A multivariate logistic regression was used to compare rates of postoperative complications between cohorts and odds ratios (ORs) were calculated to evaluate risk of postoperative complications.
Smoking was not found to be significantly correlated with any recorded complication, including surgical site infection (OR = 1.98, P = .219), sepsis (OR = 0.84, P = .879), hospital readmission (OR = 1.9, P = .136), return to operating room (OR = 1.06, P = .913), pulmonary embolism (OR = 0.91, P = .933), and blood loss requiring transfusion (OR = 0.36, P = .211).
This study suggests no significant correlation between smoking and increased rates of complications following TEA in the 30-day postoperative window, such as postoperative surgical site infection, hospital readmission, or sepsis.
This study found no significant correlation between smoking and complications within the 30-day postoperative window, supporting the safety of TEA procedures for smokers. However, perioperative smoking cessation is still recommended as part of medical optimization before surgery. The results provide a valuable tool for risk stratification in TEA patients, especially smokers, during the acute postoperative phase. Decisions regarding TEA surgery should involve shared decision-making between the surgeon and patient, considering multiple factors.