Does Smoking Cessation Prior to Elective Total Joint Arthroplasty Result in Continued Abstinence?

Smoking tobacco is a known modifiable risk factor for complications in total joint arthroplasty (TJA) patients. Patients are commonly required to quit smoking prior to TJA. After the early postoperative period, little is known about the long-term implications of this preoperative behavioral change. Our aims were to 1) identify TJA patients that had negative anabasine screen prior to elective TJA and 2) determine the long-term rates of continued smoking abstinence.

At our institution, TJA patients identified as smokers undergo urine anabasine testing prior to surgery. Between 2009 - 2018 all patients that had elective primary TJA with pre-operative urine anabasine tests were queried. Patients were called post-operatively at mean 52 months (range 15 - 126 months) and surveyed regarding smoking status. Long-term smoking cessation rates were then analyzed along with relapse time frame. The use of quit aid and patient perspective on importance of quitting were also analyzed.

249 smokers that had elective TJA were identified. 124 (50%) participated in the survey, and 93 quit to facilitate surgery. 21 (23%) never resumed smoking, and 32 (34%) were currently abstinent. Just over half of the patients relapsed in the three-month post-operative period (55%). There were no differences in quit aid or patient perspectives between these groups.

With an increased focus on smoking cessation prior to elective TJA, orthopedics contributes to an important public health initiative. Although national quit rates are in the single digits, 23% of patients were able to quit permanently.Level of Evidence: IV.