Mr. Singh has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Savient, Novartis, Takeda, URL Pharmaceuticals, and Abbott, and has received research and travel grants from Allergan, Takeda, Savient, Wyeth, and Amgen.
Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans†
Article first published online: 27 SEP 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 10, pages 1365–1374, October 2011
How to Cite
Singh, J. A., Houston, T. K., Ponce, B. A., Maddox, G., Bishop, M. J., Richman, J., Campagna, E. J., Henderson, W. G. and Hawn, M. T. (2011), Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res, 63: 1365–1374. doi: 10.1002/acr.20555
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
- Issue published online: 27 SEP 2011
- Article first published online: 27 SEP 2011
- Accepted manuscript online: 18 JUL 2011 09:39AM EST
- Manuscript Accepted: 6 JUL 2011
- Manuscript Received: 6 JAN 2011
- VA. Grant Number: IIR IAB 06-038-2
- Department of VA Medical Centers at Bedford, Massachusetts, Birmingham, Alabama
- Puget Sound, Washington
To assess the effect of smoking on postoperative complications following elective primary total hip replacement (THR) or primary total knee replacement (TKR).
We used data from the national Veterans Affairs Surgical Quality Improvement Program to examine the association of smoking status at surgery with 30-day postoperative complication rates (including surgical site and other infections, pneumonia, stroke, myocardial infarction, mortality, and other complications) in veterans undergoing primary elective THR or TKR. Multilevel multivariable-adjusted logistic regression models, adjusted for age, race/ethnicity, work relative value units, American Society of Anesthesiology classification, and year of surgery, with additional adjustment for wound classification for surgical site infections, were used.
A total of 33,336 patients, 95% men and 80% white with a mean age of 64 years, underwent elective primary THR/TKR between October 2001 and September 2008. Fifty-seven percent never smoked, 19% were prior smokers, and 24% were current smokers. Current smokers undergoing THR/TKR were significantly more likely than never smokers to have surgical site infections (odds ratio [OR] 1.41, 95% CI 1.16–1.72), pneumonia (OR 1.53, 95% CI 1.10–2.14), stroke (OR 2.61, 95% CI 1.26–5.41), and 1-year mortality (OR 1.63, 95% CI 1.31–2.02). Prior smokers were significantly more likely than nonsmokers to have pneumonia, (OR 1.34, 95% CI 1.00–1.80), stroke (OR 2.14, 95% CI 1.12–4.10), and urinary tract infection (OR 1.26, 95% CI 1.02–1.55).
Current smoking at the time of elective THR or TKR is associated with increased postarthroplasty complications, especially surgical site infections and pneumonia. Preoperative smoking cessation programs should be considered in patients undergoing elective THR or TKR.