Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT.
University of Connecticut School of Medicine, Farmington, CT.
J Arthroplasty. 2019 Jul;34(7S):S144-S147. doi: 10.1016/j.arth.2018.10.036. Epub 2018 Nov 8.
Although smoking is a well-accepted risk factor for surgical complications, the effect of smoking on patient-reported outcomes (PROs) has not been previously investigated. Prompted by an increasingly value-conscious healthcare environment, the purpose of this study is to investigate the association between smoking and PROs in total joint arthroplasty (TJA).
A retrospective review of 713 primary total hip and knee replacements was performed. Two cohorts were compared: (1) current smokers and (2) previous/never smokers at the time of TJA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-12 Physical Composite Summary (SF-12 PCS) and Short Form-12 Mental Composite Summary were assessed preoperatively and again at 6 and 12 months postoperatively. The primary outcomes were the net changes and absolute outcome scores at final follow-up. Postoperative patient satisfaction was also assessed as a secondary outcome. Linear mixed-effects regression analysis was performed.
There were significant demographic and preoperative health disparities as measured by PROs among smokers. After adjusting for baseline differences, smokers achieved significantly lower improvements in WOMAC (P = .002) and SF-12 PCS (P = .03) compared to nonsmokers. For each unit increase in packs per day smoked, the WOMAC scores increased (worsened) by 7.7 points (P = .003) and SF-12 PCS decreased by 4.8 points (P = .001). At final follow up, nonsmokers had significantly better absolute scores for all outcomes (except for mental health) and were more likely to be satisfied with surgery (89% vs 82%, P = .052).
Tobacco smoking is an independent predictor for lower PROs after TJA and this relationship is dose-dependent. The negative impact of smoking does not appear to be related to impaired psychological health. As we transition to value-based care delivery models, this study provides further evidence that smoking cessation should be strongly recommended as a modifiable risk factor before embarking on elective TJA. Studies are still needed to define the optimal window for smoking cessation.
尽管吸烟是公认的手术并发症风险因素，但吸烟对患者报告结局（PROs）的影响尚未得到研究。在日益重视医疗保健价值的环境下，本研究旨在调查吸烟与全关节置换术（TJA）中 PROs 的关系。
对 713 例初次全髋关节和膝关节置换术进行回顾性分析。比较了两个队列：（1） 当前吸烟者；（2） TJA 时为既往/从不吸烟者。术前和术后 6 个月和 12 个月评估 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）以及 12 项简短健康调查量表躯体成分综合评分（SF-12 PCS）和精神成分综合评分（SF-12 MCS）。主要结局是最终随访时的净变化和绝对结局评分。术后患者满意度也作为次要结局进行评估。采用线性混合效应回归分析。
吸烟患者的 PROs 存在显著的人口统计学和术前健康差异。调整基线差异后，与非吸烟者相比，吸烟者在 WOMAC（P=.002）和 SF-12 PCS（P=.03）方面的改善明显较低。每天吸烟包数增加一个单位，WOMAC 评分增加（恶化）7.7 分（P=.003），SF-12 PCS 降低 4.8 分（P=.001）。在最终随访时，非吸烟者在所有结局（心理健康除外）的绝对评分均显著更好，且更有可能对手术满意（89%对 82%，P=.052）。
吸烟是 TJA 后 PROs 降低的独立预测因素，且这种关系呈剂量依赖性。吸烟的负面影响似乎与心理健康受损无关。随着我们向基于价值的护理提供模式过渡，本研究进一步证明，在进行选择性 TJA 之前，应强烈建议戒烟作为一种可改变的风险因素。仍需要研究来确定戒烟的最佳时间窗。
