Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial.
BACKGROUND
Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking cessation program, initiated during the acute hospitalization period and carried out for six weeks, could reduce the number of complications following emergency surgical treatment of fractures.


METHODS
In a multicenter, single-blinded, randomized, controlled clinical trial, 105 smokers with a fracture of the lower or upper extremity that needed acute surgical treatment were randomized to an intervention group (n = 50) or a control group (n = 55). The intervention group was offered a standardized smoking cessation program for six weeks, and all patients were followed at two to three weeks, four weeks, and six to twelve weeks.


RESULTS
The proportion of patients with at least one postoperative complication was significantly larger in the control group than it was in the intervention group (38% and 20%, respectively; p = 0.048). The development of two or more postoperative complications was also more common among the controls (p = 0.039). The rates of superficial wound infection, the most frequently recorded complication in both groups, were 20% and 8%, but this difference was not significant. A secondary analysis showed that the odds of having a complication were 2.51 times (95% confidence interval, 0.96 to 6.9 times) higher in the control group than in the intervention group, but this difference was not significant.


CONCLUSIONS
Our results indicate that a smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications.
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, S-118 83 Stockholm, Sweden. nasell@sodersjukhuset.se
Hans
H
Nåsell
Johanna
J
Adami
Eva
E
Samnegård
Hanne
H
Tønnesen
Sari
S
Ponzer
D004630:Emergencies; D005121:Extremities / Q000293:injuries / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D016037:Single-Blind Method; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation