Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2023 Sep;32(9):1937-1944. doi: 10.1016/j.jse.2023.03.007. Epub 2023 Apr 6.
Nicotine in tobacco products is known to impair bone and tendon healing, and smoking has been associated with an increased rate of retear and reoperation following rotator cuff repair (RCR). Although smoking is known to increase the risk of failure following RCR, former smoking status and the timing of preoperative smoking cessation have not previously been investigated.
A national all-payer database was queried for patients undergoing RCR between 2010 and 2020. Patients were stratified into 5 mutually exclusive groups according to smoking history: (1) never smokers (n = 50,000), (2) current smokers (n = 28,291), (3) former smokers with smoking cessation 3-6 months preoperatively (n = 34,513), (4) former smokers with smoking cessation 6-12 months preoperatively (n = 786), and (5) former smokers with smoking cessation >12 months preoperatively (n = 1399). The risks of postoperative infection and revision surgery were assessed at 90 days, 1 year, and 2 years following surgery. Multivariate logistic regressions were used to isolate and evaluate risk factors for postoperative complications.
The 90-day rate of infection following RCR was 0.28% in never smokers compared with 0.51% in current smokers and 0.52% in former smokers who quit smoking 3-6 months prior to surgery (P < .001). Multivariate logistic regression identified smoking (odds ratio [OR], 1.49; P < .001) and smoking cessation 3-6 months prior to surgery (OR, 1.56; P < .001) as risk factors for 90-day infection. The elevated risk in these groups persisted at 1 and 2 years postoperatively. However, smoking cessation >6 months prior to surgery was not associated with a significant elevation in infection risk. In addition, smoking was associated with an elevated 90-day revision risk (OR, 1.22; P = .038), as was smoking cessation between 3 and 6 months prior to surgery (OR, 1.19; P = .048). The elevated risk in these groups persisted at 1 and 2 years postoperatively. Smoking cessation >6 months prior to surgery was not associated with a statistically significant elevation in revision risk.
Current smokers and former smokers who quit smoking within 6 months of RCR are at an elevated risk of postoperative infection and revision surgery at 90 days, 1 year, and 2 years postoperatively compared with never smokers. Former smokers who quit >6 months prior to RCR are not at a detectably elevated risk of infection or revision surgery compared with those who have never smoked.
烟草制品中的尼古丁已知会损害骨骼和肌腱愈合，吸烟与肩袖修复（RCR）后再撕裂和再手术的发生率增加有关。尽管吸烟会增加 RCR 后失败的风险，但以前的吸烟状况和术前戒烟的时间尚未被调查。
对 2010 年至 2020 年间接受 RCR 的患者进行了全国性的全支付者数据库查询。根据吸烟史将患者分为 5 个互斥组：（1）从不吸烟者（n=50000），（2）当前吸烟者（n=28291），（3）术前 3-6 个月戒烟的前吸烟者（n=34513），（4）术前 6-12 个月戒烟的前吸烟者（n=786），和（5）术前戒烟>12 个月的前吸烟者（n=1399）。在术后 90 天、1 年和 2 年评估术后感染和翻修手术的风险。多变量逻辑回归用于分离和评估术后并发症的危险因素。
RCR 后 90 天感染率在从不吸烟者中为 0.28%，而在当前吸烟者和术前 3-6 个月戒烟的前吸烟者中分别为 0.51%和 0.52%（P<0.001）。多变量逻辑回归确定吸烟（优势比[OR]，1.49；P<0.001）和术前 3-6 个月戒烟（OR，1.56；P<0.001）是 90 天感染的危险因素。这些组在术后 1 年和 2 年的感染风险仍然较高。然而，术前戒烟>6 个月与感染风险的显著升高无关。此外，吸烟与 90 天翻修风险的升高相关（OR，1.22；P=0.038），术前 3-6 个月戒烟也与翻修风险升高相关（OR，1.19；P=0.048）。这些组在术后 1 年和 2 年的风险仍然较高。术前戒烟>6 个月与翻修风险的升高无统计学显著相关性。
与从不吸烟者相比，RCR 后 90 天、1 年和 2 年内，当前吸烟者和术后 6 个月内戒烟的前吸烟者术后感染和翻修手术的风险较高。与从未吸烟者相比，RCR 前戒烟>6 个月的前吸烟者，感染或翻修手术的风险无明显升高。
