The Impact of Smoking on Complications After Operatively Treated Ankle Fractures—A Follow-Up Study of 906 Patients

• Published in: Journal of orthopaedic trauma Vol. 25; no. 12; pp. 748 - 755
• Main Authors: Nåsell, Hans, Ottosson, Carin, Törnqvist, Hans, Lindé, Johannes, Ponzer, Sari
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-12-2011; Lippincott Williams & Wilkins
• Subjects: Ankle Injuries - surgery; Biological and medical sciences; Bone Nails; Bone Wires; Casts, Surgical; Databases, Factual; Diseases of the osteoarticular system; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fractures, Bone - surgery; Hospitals, Teaching; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Postoperative Complications - etiology; Prospective Studies; Smoking - adverse effects; Surgical Wound Infection; Tobacco, tobacco smoking; Toxicology; Traumas. Diseases due to physical agents; Weight-Bearing; Human; Postoperative; Diseases of the osteoarticular system; Tobacco smoking; Fracture; ankle fracture; Trauma; Wound; Ankle; Infection; Ankle joint; Treatment; wound infection; Follow up study; Orthopedics; smoking; postoperative complications; Complication
• ISSN: 0890-5339; 1531-2291; 1531-2291
• DOI: 10.1097/BOT.0b013e318213f217

OBJECTIVES:This study on patients with operatively treated ankle fractures aimed to investigate the impact of smoking on postoperative complications and especially deep wound infections.
DESIGN:Cohort study with prospective follow-up.
SETTING:University-associated teaching hospital with advanced trauma care.
PATIENTS:A consecutive series of patients (n = 906) operatively treated for an acute ankle fracture during a 3-year period was identified. For the analysis, the patients were categorized as nonsmokers (n = 721) and smokers (n = 185). Data were collected from the department database and completed with a review of the patientsʼ medical charts.
MAIN OUTCOME MEASURES:Postoperative complications.
RESULTS:Follow-up data at 6 weeks were available for 98.2% of the patients. Postoperative complications of any kind (30.1% versus 20.3%, P = 0.005) as well as deep wound infections (4.9% versus 0.8%, P < 0.001) were more common among smokers than nonsmokers. Multivariable analyses showed that smokers had six times higher odds of developing a deep infection compared with nonsmokers. A more complicated fracture, associated diabetes mellitus, and unsatisfactory operative fracture reduction also enhanced the risk of postoperative complications.
CONCLUSIONS:We conclude that cigarette smoking increases the risk of postoperative complications in patients operatively treated for an ankle fracture. Smoking is a considerable risk factor. Therefore, physicians, nurses, and other healthcare professionals should strive to support patients to stop smoking while still under acute treatment.