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Smoking Cessation Success-Total Joint Arthroplasty as a Powerful Motivator
Mary E Hennekes1, Aaron Pang, Hamza M Raja
1From the Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI (Hennekes, Pang, Raja, North, and Charters), University of Michigan Medical School, Ann Arbor, MI (Rasheed), and Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA (Darrith).
Introduction:
Smoking is a well-established risk factor for perioperative complications after total joint arthroplasty (TJA), yet only 8% of people are successful at smoking cessation yearly. This study aimed to assess the success rate of smoking cessation in TJA patients through one framework and explore potential demographic factors associated with smoking cessation.
Methods:
All adult patients pursuing primary TJA and who had received smoking cessation counseling within a 2-year period (2021 to 2022) were included in this retrospective cohort study. Nicotine and cotinine blood tests were used to confirm smoking cessation after a 6-week period of self-reported abstinence. The smoking cessation interval was calculated as the duration between smoking cessation counseling and the date of normal nicotine (<2.0 ng/mL) and cotinine (<8.0 ng/mL) laboratory tests. Logistic regression analyses were conducted to determine associations between smoking cessation and demographic variables.
Results:
One hundred three patients met inclusion criteria. Thirty-two patients (31.1%) self-reported abstinence after a 6-week period of smoking cessation. Ultimately, 29 patients (28.2%) demonstrated objective evidence of smoking cessation. The time from initial smoking cessation counseling to normal labs was a median of 84.0 days (interquartile ranges: 45.5 to 178.5). Being married was a significant predictor for smoking cessation success (odds ratio: 0.26; P < 0.05). Married patients were also able to achieve success faster than their single counterparts ( P = 0.043).
Conclusion:
This study highlights the high percentage (28.2%) of smoking cessation success achieved within a single smoking cessation framework before TJA. These findings underscore the increased potential for success when smoking cessation efforts are motivated by improved function and pain relief offered by TJA. The addition of objective measures such as nicotine and cotinine testing may further increase smoking cessation rates by providing concrete measures of success.
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