Smoking cessation programs benefit patients prior to joint replacements

March 16, 2017

Smokers who needed a hip or knee replacement experienced better surgical outcomes and fewer adverse events including hospital readmissions, surgical site infections and blood clots if they were enrolled in a smoking cessation program prior to surgery, according to preliminary new research that needs to be confirmed by larger studies.

The researchers recommend that consider implementing smoking cessation programs, which may lead to better outcomes for this higher-risk patient population and reductions in health care costs. Their findings were presented March 16, 2017 at the American Academy of Orthopaedic Surgeons (AAOS) 2017 Annual Meeting in San Diego, California.

"We've known that do worse than non-smokers after joint replacements, and now this research shows there's good early evidence that quitting smoking before surgery may improve their outcomes," says lead study author Amy Wasterlain, MD, a fourth-year resident in the Department of Orthopaedic Surgery at NYU Langone. "Not every risk factor can be reduced before a , but smoking status is one that should be a top priority for orthopaedic surgeons and their patients."

Smokers who undergo a total joint replacements have a 50 percent increased risk of experiencing complications during surgery and on average, result in $5,000 more in hospital costs compared to non-smokers, according to previous research. A recent review of 7,000 joint replacements found patients who used tobacco within one month of surgery were 2.1 times more likely to develop a deep surgical infection than those who hadn't.

To combat this risk, NYU Langone developed a voluntary in October 2013 that was designed to get smokers tobacco-free within one to two weeks of surgery. The program consists of four pre-operative telephone counseling sessions and nicotine replacement therapy as needed, and two post-operative follow-up sessions.

For the new study, researchers reviewed medical records of 539 smokers who underwent total joint replacements at NYU Langone's Hospital for Joint Diseases between October 2013 - after the smoking cessation program was implemented - through March, 2016.

Of those patients who used tobacco, 103 smokers were referred to the program by their surgeons, 73 of whom voluntarily enrolled and 47 patients who completed all six sessions. The researchers found that smokers who completed the program were 4.3 times more likely to quit smoking prior to surgery than those who were not enrolled in the program. The percentage of smokers who quit all tobacco use prior to surgery increased with each level of participation in the program: 52 percent of those enrolled and 68 percent of those who completed the program quit smoking prior to surgery, compared to 18 percent of smokers who were never referred. Smokers who completed the program reduced their daily cigarette consumption by more than 10.5 cigarettes per day, compared with a nearly five cigarette per day reduction in those who participated but didn't complete the program, and only two cigarettes per day in smokers who never enrolled.

Patients who completed the program had fewer surgical complications, with a decrease in reoperation rates from 4.9 percent among all other smokers to 4.3 percent in the group in the smoking cessation program. In knee replacements alone, researchers reported in 22 percent of patients who completed the program compared to 29 percent among all other smokers - a decrease of over 24 percent. Adverse events included hospital readmission, superficial and deep surgical site infection, deep vein thrombosis, pulmonary embolism, pneumonia, stroke, and urinary tract infection.

The researchers emphasize that these findings represent trends towards better outcomes, and a larger study of more than 900 smokers, which is currently underway, is needed to determine statistical significance. Another study limitation was the absence of chemical testing to confirm patients were tobacco-free, and future studies will include this testing.

The researchers plan to build on their promising pilot study and expand the program's capacity to include all smokers undergoing a total joint replacement or other elective orthopaedic operation, says senior study author Richard Iorio, MD, the Dr. William and Susan Jaffe Professor of Orthopaedic Surgery and chief of the division of Adult Reconstructive Surgery at NYU Langone. He adds that improved outcomes following smoking cessation could be worthwhile for reducing , especially as hospitals implement bundled payment and value-based care reimbursement models such as under Medicare's mandatory Comprehensive Care for Joint Replacement (CJR) demonstration project. Under this model, hospitals assume financial responsibility for any complications over an entire care episode, including postsurgical infections and hospital readmissions.

"By delaying surgery in high-risk patients until they enroll in a program to quit smoking, we are not only improving how the patient will do after , but eliminating some of the burden on the health care system caused by poor outcomes and increases in costly reoperations," says Dr. Iorio. "Our study adds that telling patients to stop smoking likely is not enough, and an established may be most beneficial."

Explore further: After joint replacement surgery, smokers at increased risk of reoperation for infection

Related Stories

After joint replacement surgery, smokers at increased risk of reoperation for infection

February 15, 2017
For patients undergoing total hip or knee replacement, smoking is associated with an increased risk of infectious (septic) complications requiring repeat surgery, reports a study in the February 15 issue of The Journal of ...

Few smokers receive treatment to help them quit while in the hospital

March 8, 2017
It's never too late to quit smoking. Even after heart surgery, research has shown that quitting smoking reduces the risk of a heart attack, stroke or death. Yet only about one-third of smokers hospitalized for heart attacks ...

Current and past smokers face greater risk for hip replacement failure

March 20, 2013
Smoking has been linked to prolonged healing time and greater risk for complications in orthopaedic and other surgeries, according to a new study presented today at the 2013 Annual Meeting of the American Academy of Orthopaedic ...

Medicaid policies that help smokers quit also save on health care costs

October 27, 2016
Medicaid policies that require patients to go for tobacco-cessation counseling before they get a nicotine patch or some other type of anti-smoking drug actually lead to a reduction in the use of such medication, according ...

Bundled payments improve care for Medicare patients undergoing joint replacement

March 2, 2016
Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone ...

Study finds that smokers who try e-cigarettes to quit are younger and more motivated to quit

July 23, 2013
University of Hawaii Cancer Center Prevention and Control Program researchers Pallav Pokhrel, PhD and Thaddeus Herzog, PhD have found that smokers who use e-cigarettes as a tool to stop smoking tend to be younger and more ...

Recommended for you

Breathing dirty air may harm kidneys, study finds

September 21, 2017
Outdoor air pollution has long been linked to major health conditions such as heart disease, stroke, cancer, asthma and chronic obstructive pulmonary disease. A new study now adds kidney disease to the list, according to ...

Excess dietary manganese promotes staph heart infection

September 21, 2017
Too much dietary manganese—an essential trace mineral found in leafy green vegetables, fruits and nuts—promotes infection of the heart by the bacterium Staphylococcus aureus ("staph").

Being active saves lives whether a gym workout, walking to work or washing the floor

September 21, 2017
Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.

Frequent blood donations safe for some, but not all

September 21, 2017
(HealthDay)—Some people may safely donate blood as often as every eight weeks—but that may not be a healthy choice for all, a new study suggests.

Higher manganese levels in children correlate with lower IQ scores, study finds

September 21, 2017
A study led by environmental health researchers at the University of Cincinnati (UC) College of Medicine finds that children in East Liverpool, Ohio with higher levels of Manganese (Mn) had lower IQ scores. The research appears ...

One e-cigarette with nicotine leads to adrenaline changes in nonsmokers' hearts

September 20, 2017
A new UCLA study found that healthy nonsmokers experienced increased adrenaline levels in their heart after one electronic cigarette (e-cigarette) with nicotine but there were no increased adrenaline levels when the study ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.