Tobacco use predicts a more difficult episode of care after anatomic total shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery Vol. 27; no. 1; pp. 23 - 28
• Main Authors: Wells, Daniel B., Holt, Andrew M., Smith, Richard A., Brolin, Tyler J., Azar, Frederick M., Throckmorton, Thomas W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2018
• Subjects: 90-day episode of care; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - therapeutic use; Arthritis - surgery; Arthroplasty, Replacement, Shoulder - adverse effects; complications; Episode of Care; Female; Humans; Length of Stay; Male; Middle Aged; outcomes; Pain Measurement; Pain, Postoperative - etiology; postoperative pain; Reoperation; Retrospective Studies; Risk Factors; Shoulder Joint - surgery; tobacco use; Tobacco Use - adverse effects; Total shoulder arthroplasty; Treatment Outcome; Treatment Study; 90-day episode of care; complications; outcomes; postoperative pain; Retrospective Cohort Design; Total shoulder arthroplasty; tobacco use; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2017.06.033

In the current health care environment, it is becoming increasingly important to recognize risks factors that may affect a patient's postoperative outcome. To determine the potential impact of tobacco as a risk factor, we evaluated postoperative pain, narcotic use, length of stay, reoperations, and complications in the global 90-day episode of care for patients undergoing anatomic total shoulder arthroplasty (TSA) who were current tobacco users, former users, or nonusers.
Database search identified 163 patients with primary anatomic TSA done for glenohumeral arthritis; these were divided into 3 groups: current tobacco users (28), nonusers (88), and former users (47). All surgeries were done with the same technique and implants.
Patients in the current tobacco use group had significantly higher visual analog scale scores preoperatively and at 12 weeks postoperatively than nonusers and former users. Mean improvement in visual analog scale scores was significantly less in current tobacco users. Cumulative oral morphine equivalent use at 12 weeks was significantly higher in current tobacco users than in nonusers and former users. The average oral morphine equivalent per day was also significantly higher in the current tobacco users than in nonusers and former users. There were no significant differences in length of stay or complications.
Although length of stay, complication rates, hospital readmissions, and reoperation rates were not significantly different, tobacco users reported increased postoperative pain and narcotic use in the global period after TSA. Former tobacco users were found to have a postoperative course similar to that of nonusers, suggesting that discontinuation of tobacco use can improve a patient's episode of care performance after TSA.