Background Studies have suggested higher rates of peri- and post-operative complications in smokers compared to non-smokers. The objective of this systematic review was to assess the association of smoking and post-operative outcomes following total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods A search of six databases (The Cochrane Library, Scopus, Proquest Dissertation abstracts, CINAHL, OVID MEDLINE and EMBASE) was performed by a Cochrane librarian. All titles and abstracts were screened by two independent reviewers, with expertise in performing systematic reviews. Studies were included if they were fully published reports that included smoking and any perior post-operative clinical outcome in patients with either TKA or THA. Results 21 studies were included for the review, of which six included multivariable-adjusted analyses, 14 univariate analyses and one statistical modeling. For most outcomes, results from 1-2 studies could be pooled. Current smokers were significantly more likely to have any post-operative complication (risk ratio, 1.24 [95% confidence interval, 1.01 to 1.54]) and death (risk ratio, 1.63 [95% confidence interval, 1.06 to 2.51]), compared to non-smokers. Former smokers were significantly more likely to have any post-operative complication (risk ratio, 1.32 [95% confidence interval, 1.05 to 1.66]) and death (risk ratio, 1.69 [95% confidence interval, 1.08 to 2.64]). Conclusion This systematic review finds that smoking is associated with significantly higher risk of post-operative complication and mortality following THA or TKA. Studies examining long-term consequences of smoking on implant survival and complications are needed. Smoking cessation may improve outcomes after THA or TKA.
Raj N. Manickam, MS,1,2 Stavros G. Memtsoudis, MD, PhD,3,4,5 Yi Mu, MS,1 Jeehyoung Kim, MD,6 Abhijit V. Kshirsagar, MD, MPH,7 and Heejung Bang, PhD1,2,8Knee
Whether factors not under hospital’s control affect readmissions remains intensely debated in the context of the Centers for Medicare & Medicaid Services’ Hospital Readmission Reduction Program. We aimed to evaluate the potential effects of poverty, race and hospital volume on excess readmissions, with >3000 hospitals participating in “Hospital Compare”. We assessed correlations between ‘Excess Readmission Ratio’ for five eligible outcomes (including hip-knee arthroplasty) with the three area/hospital-level factors: poverty, race (percent of Black population), and hospital volume (number of discharges). Correlation coefficients of the ratios with race were approximately r=0.2; consistently larger than those with poverty, r=0–0.1. Volume showed r=0 to −0.5. Hip-knee arthroplasty showed unique findings: null correlation with poverty (r≈0); largest variability; and strong monotonicity with volume (r≈−0.5). Percent of Hispanic showed negligible correlations in secondary analysis. Penalty assessment and hospital profiling should consider areas with high percentages of Black population and small volume hospitals/providers of hip-knee surgery.
Link to article