title: The impact of smoking on complications after operatively treated ankle fractures--a follow-up study of 906 patients.
abstract: OBJECTIVE
  This study on patients with operatively treated ankle fractures aimed to investigate the impact of smoking on postoperative complications and especially deep wound infections.
  
  
  METHODS
  Cohort study with prospective follow-up.
  
  
  METHODS
  University-associated teaching hospital with advanced trauma care.
  
  
  METHODS
  A consecutive series of patients (n = 906) operatively treated for an acute ankle fracture during a 3-year period was identified. For the analysis, the patients were categorized as nonsmokers (n = 721) and smokers (n = 185). Data were collected from the department database and completed with a review of the patients' medical charts.
  
  
  METHODS
  Postoperative complications.
  
  
  RESULTS
  Follow-up data at 6 weeks were available for 98.2% of the patients. Postoperative complications of any kind (30.1% versus 20.3%, P = 0.005) as well as deep wound infections (4.9% versus 0.8%, P < 0.001) were more common among smokers than nonsmokers. Multivariable analyses showed that smokers had six times higher odds of developing a deep infection compared with nonsmokers. A more complicated fracture, associated diabetes mellitus, and unsatisfactory operative fracture reduction also enhanced the risk of postoperative complications.
  
  
  CONCLUSIONS
  We conclude that cigarette smoking increases the risk of postoperative complications in patients operatively treated for an ankle fracture. Smoking is a considerable risk factor. Therefore, physicians, nurses, and other healthcare professionals should strive to support patients to stop smoking while still under acute treatment.
authors: Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. hans.nasell@sodersjukhuset.se
authors: Hans
authors: H
authors: Nåsell
authors: Carin
authors: C
authors: Ottosson
authors: Hans
authors: H
authors: Törnqvist
authors: Johannes
authors: J
authors: Lindé
authors: Sari
authors: S
authors: Ponzer
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D001858:Bone Nails; D001864:Bone Wires; D002370:Casts, Surgical; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects*; D013530:Surgical Wound Infection; D016474:Weight-Bearing