title: Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty.
abstract: BACKGROUND
  Smoking and alcohol use impair post-operative outcomes. However, no studies include fast-track surgery, which is a multimodal-enhanced recovery programme demonstrated to improve outcome. We hypothesised that outcome is similar in smokers and alcohol users as in non-users after fast-track hip and knee arthroplasty.
  
  
  METHODS
  Prospective questionnaires on co-morbidity and smoking/alcohol use were cross-referenced with the Danish National Health Registry to investigate relationship between smoking/alcohol use and length of stay of > 4 days and readmissions ≤ 90 days after fast-track hip and knee arthroplasty.
  
  
  RESULTS
  In 3041 consecutive patients, 458 reported smoking and 216 drinking > 2 drinks a day, of which 66 did both. Smokers/alcohol users were younger than non-users (mean age: 64.3 vs. 68.0 years, P < 0.001). Multiple regression analysis showed no relation between length of stay of > 4 days and smoking (odds ratio [95% confidence interval], P) (1.34 [0.92-1.95], 0.127) or alcohol use (0.59 [0.30-1.16], 0.127). Thirty- and ninety-day readmission rate was 6.6% (n = 201) and 9.4% (n = 285). Multiple logistic regression analysis showed an increased risk of readmissions in smokers at 30 (1.60 [1.05-2.44], 0.028) but not 90-day follow-up (1.17 [0.80-1.73], 0.419). No increased risk of readmissions was found in alcohol users at 30 (0.94 [0.50-1.76], 0.838) or 90-day follow-up (0.83 [0.47-1.49], 0.532). No increased risk of specific readmissions (i.e. wound infections or pneumonia) typically related to smoking/alcohol use was found in smokers (1.56 [0.93-2.62], 0.091) or alcohol users (1.00 [0.47-2.15], 0.999) at 90-day follow-up.
  
  
  CONCLUSIONS
  Influence of smoking or alcohol use may be less pronounced in fast-track hip and knee arthroplasty compared with data with conventional care programmes.
authors: Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark. christoffer.calov.joergensen@regionh.dk
authors: C C
authors: CC
authors: Jørgensen
authors: H
authors: H
authors: Kehlet
mesh_terms: D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D011795:Surveys and Questionnaires