Patients Who Quit Smoking Had Fewer Adverse Events After Knee Replacement Interview with:
Amy Wasterlain, MD

Fourth-year orthopaedic surgery resident
NYU Langone Medical Center who led the study with Dr. Richard Iorio What is the background for this study?

Response:  We looked at smoking habits and outcomes for 539 smokers undergoing primary total hip or knee arthroplasty, 73 of whom participated in a pre-operative smoking cessation program. Patients who participated in program were 4.3 times more likely to quit than smokers who tried to quit on their own. Program participants also reduced their tobacco intake dramatically (10.6 fewer cigarettes/day) compared to smokers who didn’t participate (2.3 fewer cigarettes/day), even if they weren’t able to quit completely. Patients who completed the program before undergoing total knee arthroplasty had about 24% fewer adverse events (readmission, venous thromboembolism, stroke, urinary tract infection, pneumonia, and surgical site infection) than smokers who didn’t participate in the program. What are the main findings?

Response:  Tobacco use is a modifiable risk factor than can and should be addressed preoperatively. We found that a preoperative smoking cessation program can dramatically enhance a patient’s chance of quitting tobacco completely, and reducing tobacco use even for those who don’t quit. We present early evidence that quitting tobacco before surgery may reduce adverse outcomes, especially for patients undergoing total knee arthroplasty. What should readers take away from your report?

Response: We will continue to enroll patients in our program to increase the study’s power to detect a statistical difference in outcomes between program participants and non-participants. We also intend to start urine testing of nicotine metabolites to confirm patients’ self-reported tobacco abstinence.

No disclosures. Thank you for your contribution to the community.

Citation: Abstract presented at the March 2017 AAOS meeting

Perioperative Smoking Cessation in Total Joint Arthroplasty Patients: A Pilot Study Christina Herrero, BA, New York, NY Richard Iorio, MD, New Rochelle, NY Ana Mola, NP, New York, NY Michael Phillips, MD, New York, NY Shreya Sinha, MPH, New York, NY James D. Slover, MD, New York, NY Anna Stachel, MPH, New York, NY Amy Wasterlain, MD, New York, NY Arthroplasty patients referred to a perioperative smoking cessation program were more likely to quit and had a shorter hospital length of stay.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 17, 2017 by Marie Benz MD FAAD