If you are a smoker and you are scheduled to undergo a total hip replacement, your orthopaedic surgeon may recommend quitting prior to surgery. All of us are familiar with the health risks associated with smoking – which include cancer of the lungs, mouth, throat and other organs, as well as coronary heart disease, heart attack and stroke – and smoking is also linked to impaired wound healing and an increased risk of complications after surgery.
Researchers at the University of California in San Diego carried out a study to determine whether smoking has an adverse effect on patient outcomes following total hip replacement surgery.
Research aims
It used information from the National Surgical Quality Improvement Programme (NSQIP) database to identify whether patients who were smokers in the year leading up to their hip replacement were more likely to experience post-operative complications in the 30 days after surgery. The researchers also considered whether these patients had increased rates of pulmonary, renal, vascular or cardiac outcomes, increased numbers of transfusions or an extended hospital stay.
Methodology
Data from the year 2016 was used to maintain variable uniformity and, in total, 67,897 patients were considered. Of these, 9,378 (13.8%) were people who had actively smoked in the year before their operation while 58,519 (86.2%) were non-smokers.
Findings
After controlling for variables, the researchers found there was a significant increase in pulmonary and infectious complications in patients who smoked, as well as the risk of an extended hospital stay. There are a number of reasons for this. Smoking is known to cause damage to airways and because a general anaesthetic leads to reduced lung volumes, atelectasis and reduced lung muscle function, the risk of pulmonary complication and a prolonged recovery period are greater among smokers. Nicotine acts as an immunosuppressant which hinders wound healing and contributes to higher rates of infectious complications among smokers. An extended stay in hospital has been shown to affect patient morbidity, mortality and quality of care, so those who remain in hospital for longer are at risk of poorer outcomes overall.
The research team acknowledged that there were some limitations to the study. The data did not show how long the patients studied had been smoking prior to their hip replacement or how many cigarettes they smoked each day. Patients who had quit smoking a year or more before the study were not differentiated from those who had never smoked and the study did not reveal potential difference in outcomes among patients who quit smoking in the months leading up to their operation. Nevertheless, it can safely be concluded that there is an increased risk of poorer outcomes, more complications and a longer stay in hospital following hip replacement surgery if you are a smoker.
Quitting makes a difference
This is why we encourage patients who are undergoing any type of surgery, but particularly a major procedure like a total hip replacement to quit. And, even just a few weeks without smoking can make a difference.
A joint study by the World Health Organisation, the University of Newcastle Australia and the World Federation of Societies of Anaesthiologists, published in 2020, found that smokers who quit four weeks or more before surgery had a lower risk of complications and better outcomes six months afterwards than those who did not. In fact, every tobacco-free week after this four week period was shown to improve health outcomes by 19%. The WHO attributes this to improved blood flow throughout the body to the essential organs.
If you are due to undergo a total hip replacement and would like to give up smoking beforehand, talk to us. We can offer information and signpost you to resources that might be able to help.
