Abstract
PurposeTo determine the efficacy of mandatory preoperative nicotine cessation on postoperative nicotine use, and to identify independent predictors of nicotine use relapse in subjects undergoing hip preservation surgery or total hip arthroplasty by a single fellowship-trained orthopedic surgeon.MethodsConsecutive subjects that underwent hip surgery from November 2014 to December 2017 were reviewed. Subjects who self-reported nicotine use, quit prior to surgery, and completed a minimum one-year follow-up were included. Multiple linear regression models were constructed to determine the effect of independent variables on nicotine use relapse following surgery.ResultsSixty subjects were included in the study (mean follow-up 35.1 months (17-57 months), mean age 44.9 years (20-82 years), and 23 (38.3%) males). Twenty-eight subjects (46.7%) remained nicotine-free at final follow-up. The mean number of cigarettes per day decreased from 13.4 preoperatively to 8.4 postoperatively in the subjects who relapsed (P=0.002). The mean time to return to nicotine postoperatively was 2.4 months. The number of preoperative cigarettes per day was the only independent predictor of tobacco use relapse (P=0.005).ConclusionMandatory preoperative nicotine cessation prior to elective hip surgery demonstrates a 46.7% nicotine-free survivorship at final follow-up with the number of preoperative cigarettes per day found to be the only independent predictor of nicotine use relapse.Level of evidenceThe level of evidence of this research study is Level III since it is a non-experimental study with a cohort of patients.
Highlights
Tobacco use in the United States remains problematic, despite a long-term decline [1]
Sixty subjects were included in the study (mean follow-up 35.1 months (17-57 months), mean age 44.9 years (20-82 years), and 23 (38.3%) males)
The mean time to return to nicotine postoperatively was 2.4 months
Summary
Tobacco use in the United States remains problematic, despite a long-term decline [1]. It remains the leading cause of preventable death in the U.S with cigarette smoking responsible for more than 480,000 deaths each year according to the Centers for Disease Control and Prevention (CDC) [2]. Smokers are at a higher risk for surgical and postoperative complications [6,7,8,9,10,11]. In an analysis of a large national database, Duchman et al found that smokers had an increased risk of wound complications and deep infections [13]. Evidence suggests that smoking cessation as early as four weeks preoperatively significantly reduces the
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