Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford.
Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol.
Acta Orthop. 2019 Dec;90(6):559-567. doi: 10.1080/17453674.2019.1649510. Epub 2019 Aug 2.
Background and purpose - Smoking is a modifiable risk factor that may adversely affect postoperative outcomes. Healthcare providers are increasingly denying smokers access to total hip and knee arthroplasty (THA and TKA) until they stop smoking. Evidence supporting this is unclear. We assessed the effect of smoking on outcomes following arthroplasty.Patients and methods - We identified THAs and TKAs from the Clinical Practice Research Datalink, which were linked with datasets from Hospital Episode Statistics and the Office for National Statistics to identify outcomes. The effect of smoking on postoperative outcomes (complications, medications, revision, mortality, patient-reported outcome measures [PROMs]) was assessed using adjusted regression models.Results - We studied 60,812 THAs and 56,212 TKAs (11% smokers, 33% ex-smokers, 57% non-smokers). Following THA, smokers had an increased risk of lower respiratory tract infection (LRTI) and myocardial infarction compared with non-smokers and ex-smokers. Following TKA, smokers had an increased risk of LRTI compared with non-smokers. Compared with non-smokers (THA relative risk ratio [RRR] = 0.65; 95% CI = 0.61-0.69; TKA RRR = 0.82; CI = 0.78-0.86) and ex-smokers (THR RRR = 0.90; CI = 0.84-0.95), smokers had increased opioid usage 1-year postoperatively. Similar patterns were observed for weak opioids, paracetamol, and gabapentinoids. 1-year mortality rates were higher in smokers compared with non-smokers (THA hazard ratio [HR] = 0.37, CI = 0.29-0.49; TKA HR = 0.52, CI = 0.34-0.81) and ex-smokers (THA HR = 0.53, CI = 0.40-0.70). Long-term revision rates were not increased in smokers. Smokers had improvement in PROMs compared with preoperatively, with no clinically important difference in postoperative PROMs between smokers, non-smokers, and ex-smokers.Interpretation - Smoking is associated with more medical complications, higher analgesia usage, and increased mortality following arthroplasty. Most adverse outcomes were reduced in ex-smokers, therefore smoking cessation should be encouraged before arthroplasty.
背景与目的-吸烟是一种可改变的风险因素，可能会对术后结果产生不利影响。医疗保健提供者越来越多地拒绝吸烟者接受全髋关节和膝关节置换术（THA 和 TKA），直到他们戒烟。支持这一观点的证据尚不清楚。我们评估了吸烟对关节置换术后结果的影响。
患者与方法-我们从临床实践研究数据库中确定了 THA 和 TKA，并与医院事件统计数据和国家统计局数据集进行了链接，以确定结果。使用调整后的回归模型评估吸烟对术后结果（并发症、药物治疗、翻修、死亡率、患者报告的结果测量[PROMs]）的影响。
结果-我们研究了 60812 例 THA 和 56212 例 TKA（11%为吸烟者，33%为前吸烟者，57%为非吸烟者）。与非吸烟者和前吸烟者相比，吸烟者在接受 THA 后发生下呼吸道感染（LRTI）和心肌梗死的风险增加。与非吸烟者相比，吸烟者在接受 TKA 后发生 LRTI 的风险增加。与非吸烟者（THA 相对风险比[RRR] = 0.65；95%CI = 0.61-0.69；TKA RRR = 0.82；CI = 0.78-0.86）和前吸烟者（THR RRR = 0.90；CI = 0.84-0.95）相比，吸烟者在术后 1 年内使用阿片类药物的量增加。在弱阿片类药物、对乙酰氨基酚和加巴喷丁类药物中也观察到类似的模式。与非吸烟者相比，吸烟者的 1 年死亡率更高（THA 风险比[HR] = 0.37，CI = 0.29-0.49；TKA HR = 0.52，CI = 0.34-0.81）和前吸烟者（THA HR = 0.53，CI = 0.40-0.70）。吸烟者的长期翻修率没有增加。与术前相比，吸烟者的 PROMs 有所改善，且吸烟者、非吸烟者和前吸烟者之间的术后 PROMs 没有临床上有意义的差异。
结论-吸烟与关节置换术后更多的医疗并发症、更高的镇痛药物使用和更高的死亡率相关。大多数不良结局在前吸烟者中减少，因此应在关节置换术前鼓励戒烟。
