Smoking Cessation Before and After Total Joint Arthroplasty-An Uphill Battle

Patients actively smoking at the time of primary total joint arthroplasty (TJA) are at increased risk of perioperative complications. Employing strategies for smoking cessation has therefore become routine. A potential benefit of cessation in anticipation of TJA may be long-term cessation. However, success rates and the longevity of successful smoking cessation attempts before TJA have yet to be presented.

Our institution's total joint registry documents self-reported smoking status. As such, all patients who underwent TJA from 2007 to 2018 were identified and grouped as nonsmokers, smokers (regularly smoking within 1 year before surgery), and former smokers (those who quit smoking within 1 year before surgery). Thereafter, postoperative smoking status was assessed with special attention to former smokers to see who remained smoke-free.

From the 28,758 primary TJAs identified, 91.3% (26,244) were nonsmokers, 7.3% (2109) were smokers, and 1.4% (405) had quit smoking before surgery. Among former smokers, 86% were abstinent 1 year postoperatively but only 45% were still abstinent 8 years postoperatively. Conversely, 7% of smokers at the time of surgery eventually quit and 6% of prior nonsmokers started smoking over the same time period.

Despite concerted efforts to help patients stop smoking before TJA, 7.3% remain smokers. Among those who are successful, less than half (45%) remain smoke-free after surgery. Compared to current smokers, however, patients who managed to quit before surgery are more likely to remain smoke-free after surgery. These findings demonstrate the tremendous challenge smoking represents in contemporary TJA practices.

Therapeutic level III.