title: Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study.
abstract: BACKGROUND
  Tobacco smoking is a risk factor for several adverse post-operative outcomes. We aimed to compare the rates of complications in current tobacco users and non-users who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).
  
  
  METHODS
  All patients who underwent primary THA or TKA at the Mayo Clinic from 2010-2013 were included in the study. Current tobacco use was defined as the use of cigarettes, cigars, pipes, or smokeless tobacco reported at the time of index THA or TKA; current non-users were former users or never users. We used Cox proportional hazards regression to assess the association of current tobacco use status with each post-THA/TKA complication, using hazard ratios and 95% confidence intervals (CI).
  
  
  RESULTS
  Tobacco use status was available for 7926 patients (95%) and not available for 446 patients (5%); 565 (7%) were current tobacco users. Compared to non-users, current tobacco users were more likely to be male (p < 0.001), and less likely to be obese (p ≤ 0.008), be older than 60 years, have Charlson score >0 or have undergone TKA rather than THA (p < 0.001 each). The hazard ratios for deep infection (2.37; 95% CI 1.19, 4.72; p = 0.01) and implant revision (1.78; 95% CI 1.01, 3.13; p = 0.04) were higher in current tobacco users than in non-users. No significant differences were noted for periprosthetic fractures or superficial infections.
  
  
  CONCLUSIONS
  We noted that current tobacco use was associated with high risk of deep infection and implant revision after primary THA or TKA. Future studies should determine the optimal time for tobacco use cessation before elective surgeries such as THA and TKA to improve short-term and long-term arthroplasty outcomes.
authors.affiliation: Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, VA Medical Center, Faculty Office Tower, 510, 20th Street South, 805B, Birmingham, AL, 35294, USA. Jasvinder.md@gmail.com.|Department of Medicine at School of Medicine and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. Jasvinder.md@gmail.com.|Department of Biostatistics, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA. Jasvinder.md@gmail.com.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Department of Biostatistics, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Schleck
authors.affiliation: Department of Biostatistics, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Jacob
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Lewallen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000523:psychology / Q000601:surgery; D064424:Tobacco Use / Q000009:adverse effects / Q000503:physiopathology