Effects of smokeless tobacco use on primary total shoulder arthroplasty outcomes

Total shoulder arthroplasty (TSA) is a common procedure performed to treat a variety of shoulder pathology. Smokeless tobacco use in the United States has increased in recent years and prior studies have found smokeless tobacco use to be associated with increased rates of medical and surgical complications following lower extremity total joint arthroplasty. The purpose of this study is to evaluate the effects of perioperative smokeless tobacco use on the short-term postoperative outcomes following primary TSA.

The Nationwide Readmissions Database was queried to identify patients who underwent primary TSA between 2016 and 2020. This cohort was further stratified into 3 cohorts: tobacco smokers, smokeless tobacco users, and nontobacco users. Subjects in both tobacco cohorts were matched at a 1:3 ratio with nontobacco users based on age, sex, and the presence of specific comorbid conditions. Demographics, postoperative complications, readmissions, revision, and mortality rates within 180 days of TSA were compared between the 3 groups.

Patients who use smokeless tobacco present with a greater mean Charlson-Deyo Comorbidity Index (5.1% vs. 1.8%) and concomitant alcohol use (5.1% vs. 1.8%). Smokeless tobacco users experienced significantly higher rates of Acute Respiratory Disease Syndrome (1.9% vs. 0.8%), sepsis (0.4% vs. 0.0%), and mortality (0.8% vs. 0.1) at 180 days.

Patients undergoing primary TSA who use smokeless tobacco are at an increased risk of mortality at 180 days and several medical postoperative complications including sepsis. Identifying these patients prior to their procedure and engaging in patient-centered discussion can help improve patient outcomes following primary TSA.