Durability of Smoking Cessation for Elective Lower Extremity Orthopaedic Surgery

Smoking tobacco is a risk factor for impaired wound healing, infection, delayed fracture healing, and prolonged hospital stay. Smoking cessation before surgery has shown a 40% relative risk reduction in total perioperative complications. The primary purpose of this study was to evaluate the effectiveness of preoperative smoking cessation on long-term smoking habits in patients undergoing elective lower extremity orthopaedic surgery. The secondary outcome is patient-reported effectiveness of the smoking cessation method.

A retrospective cohort study was performed by identifying all patients who were smokers that were required to quit and subsequently had a normal nicotine/cotinine serum test before lower extremity orthopaedic surgery. Attempts were made to contact all patients and administer a survey inquiring about their demographics, medical history, smoking history, smoking cessation process, and the current smoking status.

Of 36 eligible patients, 23 completed the survey. Eleven patients identified as current nonsmokers (48%) at the time of survey follow-up (mean follow-up was 55 months with a range of 12 to 88 months). Of these 11, 82% said they were very likely to continue to refrain from smoking. Twelve patients identified as current smokers at the time of survey, and more than half of them stopped smoking for at least three months perioperatively. The most effective smoking cessation techniques reported were "cold turkey," "nonnicotine medication," and "transdermal nicotine patches."

Elective surgery offers a unique opportunity for smoking cessation. Of 23 patients required to quit smoking before surgery, 48% maintained smoking cessation for at least one year postoperatively. Of the 12 patients who relapsed, 55% stated that they did not resume smoking until at least 3 months postoperatively, suggesting that this particular period may be an important time for intensified smoking cessation counseling.

Therapeutic level III.