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31-07-2011 | Psychology | Article

Smoking cessation recommended before knee, hip replacement


Free abstract

MedWire News: Patients scheduled to undergo total hip or knee replacement (THR/TKR) should be encouraged to give up smoking, say US researchers who found the habit increases the risk for postoperative pneumonia and other conditions.

"The smoking-associated risk of complications is quite significant; therefore, approaching these patients for a pre-operative smoking cessation intervention seems very reasonable," say Jasvinder Singh (University of Alabama at Birmingham) and co-authors.

The team examined data from the Veterans Association Surgical Quality Improvement Program for 33,336 patients, aged an average of 64 years, who underwent primary THR or TKR between 2001 and 2008. The majority of the patients were White (80%) and male (95%).

The researchers determined the 30-day rate of postoperative complications in the patients including surgical site infection, other infections, pneumonia, stroke, myocardial infarction, and death.

Overall, 24% of the patients were current smokers, while 19% had a history of smoking and 57% had never smoked.

After adjusting for confounding factors including age, race, and American Society of Anesthesiology Physical Status, current smokers were significantly more likely than never smokers to experience surgical site infections (odds ratio [OR]=1.41), pneumonia (OR=1.53), or stroke (OR=2.61).

In addition, current smoking was associated with an increased risk for death within 1 year of surgery compared with never smoking (OR=1.63).

Patients with a history of smoking also had a significantly increased risk for postoperative complications than never smokers, including pneumonia (OR=1.34), stroke (OR=2.14), and urinary tract infection (OR=1.26).

Further analysis showed a positive association between pack-years of smoking and risk for complications but the greatest risks were largely restricted to the heaviest smokers. Compared with never smokers, patients with a 60 or more pack years were at significant increased risk for surgical site infection (OR=1.76), vascular (OR=2.20) and pulmonary (OR=2.29) complications, and 1-year mortality (OR=1.85).

"For an elective surgery such as THR/TKR, the pre-operative period provides a golden opportunity for quitting," say the researchers, noting that long-term, heavy smokers may experience the greatest benefit.

They conclude: "Studies of different approaches to pre-operative smoking cessation are needed to address this important problem and to find the most optimal approach to pre-operative smoking cessation."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lynda Williams

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