Llombart-Blanco Rafael, Mariscal Gonzalo, Khalil Ibrahim, Barrios Carlos, Llombart-Ais Rafael
Orthopedic Surgery Department, University Clinic of Navarra, Pamplona, Spain.
Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain.
Shoulder Elbow. 2025 Mar 29:17585732251327368. doi: 10.1177/17585732251327368.
Although advancements in surgical techniques and postoperative management have improved outcomes, the impact of smoking on shoulder arthroplasty outcomes remains controversial. This study aimed to evaluate the influence of smoking on shoulder arthroplasty outcomes and provide a clearer perspective on the controversy surrounding the impact of smoking on medical and surgical complications.
A systematic search was conducted using four Library databases. PROSPERO (CRD42023444819). The quality of the studies was assessed using the Methodological Index for Non-randomized Studies. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated for the dichotomous and continuous variables. This study used the PICOS strategy to identify studies with patients undergoing shoulder arthroplasty surgery, with smoking as the intervention, non-smoking as the comparison, and postoperative complications as the outcome.
The meta-analysis included eight studies with 227,329 patients. The smoking group had a higher risk of readmission (OR: 1.11, 95% CI [1.05-1.17]), revision (OR: 2.32, 95% CI [1.28-4.23]), periprosthetic fracture (OR: 1.38, 95% CI [1.24-1.53]), and surgical site infection (OR: 2.09, 95% CI [1.77-2.47]), but no significant differences were found in wound problems or thromboembolic events. The smoking group had a higher risk of sepsis (OR: 1.31, 95% CI [1.07-1.60]). There were no significant differences in renal complications, urinary tract infections, pulmonary complications, or myocardial infarctions between the two groups.
Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce the costs associated with complications and joint replacement in patients undergoing shoulder arthroplasty.
These findings emphasize the need to promote a tobacco-free lifestyle and improve surgical outcomes. Preoperative interventions should include education, counseling, and support, fostering better shoulder arthroplasty results and long-term well-being.
尽管手术技术和术后管理的进步改善了治疗效果，但吸烟对肩关节置换术结果的影响仍存在争议。本研究旨在评估吸烟对肩关节置换术结果的影响，并为围绕吸烟对医疗和手术并发症影响的争议提供更清晰的观点。
使用四个图书馆数据库进行系统检索。PROSPERO（CRD42023444819）。使用非随机研究方法学指数评估研究质量。计算二分变量和连续变量的比值比（OR）和95%置信区间（CI）的平均差（MD）。本研究采用PICOS策略来识别接受肩关节置换手术的患者、以吸烟为干预措施、以不吸烟为对照、以术后并发症为结果的研究。
荟萃分析纳入了八项研究，共227329名患者。吸烟组再次入院风险更高（OR：1.11，95%CI[1.05-1.17]）、翻修风险更高（OR：2.32，95%CI[1.28-4.23]）、假体周围骨折风险更高（OR：1.38，95%CI[1.24-1.53]）以及手术部位感染风险更高（OR：2.09，95%CI[1.77-2.47]），但在伤口问题或血栓栓塞事件方面未发现显著差异。吸烟组败血症风险更高（OR：1.31，95%CI[1.07-1.60]）。两组在肾脏并发症、尿路感染、肺部并发症或心肌梗死方面无显著差异。
吸烟是一个可改变的风险因素，应加以解决，以改善接受肩关节置换术患者的治疗效果，降低与并发症和关节置换相关的成本。
这些发现强调了促进无烟生活方式和改善手术效果的必要性。术前干预应包括教育、咨询和支持，以获得更好的肩关节置换术效果和长期健康。
