Yet More Data on Smoking and Poor Outcomes

There are many negative documented health outcomes from smoking, and a new study just added to the list: Smokers often have poorer outcomes after hip arthroscopy than nonsmokers.

In the study, “Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complication in 18,585 Cases,” published recently online in The American Journal of Sports Medicine, researchers investigated the effect smoking has on patient-reported outcomes, complication rates and rate of revision after hip arthroscopy. The systematic review included studies published between January 1, 1985 and January 14, 2020.

According to the data collected, postoperative scores were better for nonsmokers for the Harris Hip Score (75.67 ± 20.88 vs. 82.32 ± 15.5; p = .001), the Visual Analog Scale pain (3.13 ± 2.79 vs. 2.13 ± 2.21; p < .001), and the Hip Outcome Score –Sports Specific (62.54 ± 25.38 vs. 71.7 ± 23.3; p < .001).

No differences were found between the two groups when it came to the score for Visual Analog Scale for pain and satisfaction (p = .23) or Hip Outcome Score-Activities of Daily Living (p = .13). Neither were there any significant differences in how much patient-reported outcomes (PROs) improved from baseline or in the rates of revision arthroscopy (p = .47) and total hip arthroscopy (THA) conversion (p = .31).

Smokers did, however, have higher rates of postoperative thromboembolic (p = .0177) and infectious (p = .006) complications.

The researchers wrote, “Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.”

Smoking increases the risk for complications after other surgeries as well. A joint study by the World Health Organization, the University of Newcastle, Australia, and the World Federation of Societies of Anesthesiologists released earlier this year found that every tobacco-free week after four weeks improves health outcomes by 19%. The reason they say is the improved blood flow throughout the body.

Besides damaging the lungs, smoking can decrease oxygen levels and increase the risk for heart issues and other complications after surgery. It also weakens the immune system.

“The report provides evidence that there are advantages to postponing minor or non-emergency surgery to give patients the opportunity to quit smoking, resulting in a better health outcome,” said Dr. Vinayak Prasad, head of Unit, No Tobacco, World Health Organization.

“Complications after surgery present a large burden for both the health care provider and the patient. Primary care physicians, surgeons, nurses and families are important in supporting a patient to quit smoking at every stage of care, especially before an operation,” added Dr. Shams Syed, coordinator of quality of care for the World Health Organization.