Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
To our knowledge, well-designed studies that have examined the risk of post-arthroplasty implant-related complications after TKA with tobacco use are lacking. Our objective was to assess the effect of current tobacco use on surgical outcomes after primary TKA. We hypothesized that current tobacco use will be associated with an increased risk of infection, revision and wound complications after primary TKA.
Methods:
This observational cohort study included all patients who underwent primary TKA at the Mayo Clinic from 2010 to 2013 and had tobacco use status documented in the Mayo Clinic’s nursing database. Current tobacco use status was the predictor of interest. It was defined based on the documentation of cigarette, cigar, pipe or smokeless tobacco use in the nursing database. Current smokers were defined as people who were using cigarettes, cigars, pipes or smokeless tobacco at the time of their surgery. They were compared to current non-smokers and former smokers with regards to post-TKA complications.
Results:
Tobacco use data at the time of TKA were available for 4,227 (95%) TKA patients and not available for 249 (5%) of the patients; mean age (67 vs. 66), BMI (33 vs. 33) and Charlson index (1.5 vs. 1.4) were similar for patients with and without tobacco use data.
There were 228 current tobacco users (5%) and 4,049 non-users (95%) among patients who underwent primary TKA. Compared to the non-users, current tobacco users who underwent primary TKA were more likely to be male, have higher Charlson index and less likely to be older than 80 years (p<0.01; reference ≤60 years). No significant differences in BMI, ASA class or implant fixation were noted.
Compared to non-smokers, smokers had 2.51 times higher hazard of any revision after primary TKA (p=0.02; Table 1). Rates of revision for infection, wound complications and any infection showed a trend towards statistical significant with hazard ratios of 2.59 (p=0.07) ,1.84 (p=0.10) and 1.94 (p=0.12), respectively. Rates of deep infection, superficial infection and periprosthetic fracture were higher for current smokers, but were not significantly different between current smokers and non-smokers.
Conclusion:
Current tobacco use was a risk factor for poor postoperative outcomes after total knee arthroplasty, including higher revision rates and the risk of wound complications. Perioperative smoking cessation efforts need to be incorporated into routing post-TKS care to prevent these complications after this elective surgery, aimed at improving patient’s quality of life.
|
Table 1. Kaplan-Meier survival analyses for current smokers compared to current non-smokers (former smokers and never smokers) |
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|
Endpoint |
Variable |
# events |
1 year (95% CI) |
2 years (95% CI) |
HR (95% CI) |
p-value |
|
Any revision |
Current tobacco user |
7 |
97.8 (95.3,100) |
93.3 (88.5,98.4) |
2.51 (1.14,5.54) |
0.02 |
|
|
Past user or never used |
50 |
98.7 (98.3,99.2) |
97.7 (97.0,98.4) |
1.0 (ref)
|
|
|
Revision for aseptic loosening |
Current tobacco user |
0 |
100 |
100 |
1.99 (0.08,52.2) |
0.68 |
|
|
Past user or never used |
4 |
100 (99.9,100) |
99.8 (99.6,100) |
1.0 (ref)
|
|
|
Revision for infection |
Current tobacco user |
4 |
100 |
95.4 (91.1,99.9) |
2.59 (0.92,7.31) |
0.07 |
|
|
Past user or never used |
28 |
99.1 (98.6,99.5) |
98.7 (98.2,99.2) |
1.0 (ref)
|
|
|
Revision for peri-prosthetic fracture |
Current tobacco user |
0 |
100 |
100 |
3.59 (0.09,147.8) |
0.50 |
|
|
Past user or never used |
2 |
99.9 (99.8,100) |
99.9 (99.7,100) |
1.0 (ref)
|
|
|
Complication deep infection |
Current tobacco user |
3 |
99.5 (98.5,100) |
97.2 (93.3,100) |
1.76 (0.54,5.77) |
0.35 |
|
|
Past user or never used |
31 |
98.9 (98.5,99.4) |
098.6 (98.1,99.1) |
1.0 (ref)
|
|
|
Complication superficial infection |
Current tobacco user |
3 |
98.3 (96.5,100) |
98.3 (96.5,100) |
2.12 (0.64,7.01) |
0.22 |
|
|
Past user or never used |
25 |
99.2 (98.8,99.5) |
99.2 (98.8,99.5) |
1.0 (ref)
|
|
|
Complication any infection |
Current tobacco user |
6 |
97.8 (95.7,100) |
95.5 (91.8,99.4) |
1.94 (0.83,4.52) |
0.12 |
|
|
Past user or never used |
56 |
98.1 (97.6,98.6) |
97.8 (97.2,98.4) |
1.0 (ref)
|
|
|
Complication wound complications |
Current tobacco user |
8 |
95.2 (92.0,98.6) |
95.2 (92.0,98.6) |
1.84 (0.88,3.8) |
0.10 |
|
|
Past user or never used |
77 |
97.5 (97.0,98.1) |
97.5 (96.9,98.0) |
1.0 (ref)
|
|
|
Complication peri-prosthetic fracture |
Current tobacco user |
2 |
99.1 (97.9,100) |
99.1 (97.9,100) |
1.15 (0.27,4.78) |
0.85 |
|
|
Past user or never used |
31 |
99.2 (98.9,99.5) |
99.0 (98.6,99.4) |
1.0 (ref)
|
|
To cite this abstract in AMA style:
Singh JA. Current Tobacco Use and the Rates of Postoperative Complications after Total Knee Arthroplasty [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/current-tobacco-use-and-the-rates-of-postoperative-complications-after-total-knee-arthroplasty/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-tobacco-use-and-the-rates-of-postoperative-complications-after-total-knee-arthroplasty/