White Christopher A, Dominy Calista L, Tang Justin E, Pitaro Nicholas L, Patel Akshar V, Wang Kevin C, Kim Jun S, Cho Samuel K, Cagle Paul J
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Shoulder Elbow. 2023 Sep;15(1 Suppl):71-79. doi: 10.1177/17585732221102393. Epub 2022 May 22.
Tobacco carcinogens have adverse effects on bone health and are associated with inferior outcomes following orthopedic procedures. The purpose of this study was to assess the impact tobacco use has on readmission and complication rates following shoulder arthroplasty.
The 2016-2018 National Readmissions Database was queried to identify patients who underwent anatomical, reverse, and hemi-shoulder arthroplasty. codes Z72.0 × (tobacco use disorder) and F17.2 × (nicotine dependence) were used to define "tobacco-users." Demographic, 30-/90-day readmission, surgical complication, and medical complication data were collected. Inferential statistics were used to analyze complications for both the cohort as a whole and for each procedure separately (i.e. anatomical, reverse, and hemiarthroplasty).
164,527 patients were identified (92% nontobacco users). Tobacco users necessitated replacement seven years sooner than nonusers ( < 0.01) and were more likely to be male (52% vs. 43%; < 0.01). Univariate analysis showed that tobacco users had higher rates of readmission, revisions, shoulder complications, and medical complications overall. In the multivariate analysis for the entire cohort, readmission, revision, and complication rates did not differ based on tobacco usage; however, smokers who underwent reverse shoulder arthroplasty in particular were found to have higher 90-day readmission, dislocation, and prosthetic complication rates compared to nonsmokers.
Comparatively, tobacco users required surgical correction earlier in life and had higher rates of readmission, revision, and complications in the short term following their shoulder replacement. However, when controlling for tobacco usage as an independent predictor of adverse outcomes, these aforementioned findings were lost for the cohort as a whole. Overall, these findings indicate that shoulder replacement in general is a viable treatment option regardless of patient tobacco usage at short-term follow-up, but this conclusion may vary depending on the replacement type used.
烟草致癌物对骨骼健康有不良影响，并且与骨科手术后较差的预后相关。本研究的目的是评估吸烟对肩关节置换术后再入院率和并发症发生率的影响。
查询2016 - 2018年全国再入院数据库，以识别接受解剖型、反置型和半肩关节置换术的患者。使用编码Z72.0×（烟草使用障碍）和F17.2×（尼古丁依赖）来定义“吸烟者”。收集人口统计学数据、30/90天再入院率、手术并发症和医疗并发症数据。使用推断统计学方法对整个队列以及每种手术（即解剖型、反置型和半关节置换术）分别进行并发症分析。
共识别出164,527例患者（92%为非吸烟者）。吸烟者比非吸烟者提前七年需要进行置换（<0.01），且更可能为男性（52%对43%；<0.01）。单因素分析显示，吸烟者总体上再入院率、翻修率、肩部并发症和医疗并发症发生率更高。在整个队列的多因素分析中，再入院率、翻修率和并发症发生率在吸烟与否方面没有差异；然而，特别是接受反置型肩关节置换术的吸烟者，与不吸烟者相比，90天再入院率、脱位率和假体并发症发生率更高。
相比之下，吸烟者在生命早期就需要手术矫正，并且在肩关节置换术后短期内再入院率、翻修率和并发症发生率更高。然而，当将吸烟作为不良结局的独立预测因素进行控制时，上述整个队列的研究结果不再显著。总体而言，这些研究结果表明，在短期随访中，无论患者是否吸烟，肩关节置换术一般都是一种可行的治疗选择，但这一结论可能因所使用的置换类型而异。
