According to the Office for National Statistics, around 6.9 million people over the age of 18 smoke in the UK. More men smoke than women (15.9% compared to 12.5%) and smoking is more prevalent among people in routine and manual occupations – where approximately one in four people smoke (23.4%) – compared to those in managerial and professional occupations (9.3%).
If you are scheduled to undergo joint replacement surgery, your orthopaedic surgeon will ask you about your overall health, including whether or not you smoke. This is because smoking significantly increases your risk of complications after surgery, as repeated studies have shown.
How smoking affects healing after surgery
Smoking affects wound healing in a number of different ways. There are many toxic components in cigarette smoke, including nicotine, carbon monoxide and hydrogen cyanide. Nicotine reduces nutritional blood flow to the skin which can impair the healing of injured tissues and result in tissue ischaemia. The risk of thrombotic microvascular occlusion is higher, as nicotine increases platelet adhesiveness, and it reduces the number of red blood cells. Hydrogen cyanide inhibits the transportation of oxygen to the cells and carbon monoxide has a similar effect and also diminishes metabolism.
What the research shows
In February 2017, The Journal of Bone and Joint Surgery published the findings of a research study showing that smokers were significantly more likely to need further surgery following an infection compared to non-smokers. The study examined 15,264 patients undergoing joint replacement surgery between 2000 and 2014. At the time of surgery, 9% were smokers, 34% were former smokers and 57% were non-smokers. The average age of current smokers was around 58 years compared to 63 years in non-smokers.
Although the risk of needing further surgery within 90 days due to infection was low (just 0.7%), smokers were at a significantly higher risk (80%) compared to non-smokers, after adjustment for other characteristics. They were also more likely to be suffering from major respiratory and cardiovascular diseases.
Should you quit smoking before surgery?
Another study, presented at the annual meeting of the American Academy of Orthopaedic Surgeons in 2017, reported that the risk of complications after knee or hip replacement surgery can be reduced by quitting smoking beforehand.
Conducted at the NYU Langone Medical Centre in New York City it looked at over 500 smokers who underwent a total knee or hip replacement. Around 100 of them were referred to a specially-developed program to help them quit. Although fewer than 50 of them completed the smoking cessation program, those who did had better surgical outcomes and had lower rates of post-surgical problems, such as hospital readmissions, surgical site infections and blood clots. In the case of patients undergoing knee replacements, the rate of complications was around a quarter lower among those who completed the programme compared to those who didn’t. This led the study authors to conclude that surgeons should actively encourage people who smoke to quit before their surgery to improve their chances of making a full recovery.
If you are scheduled to undergo joint replacement surgery we will carry out a full health check as part of our pre-operative planning process. If you smoke you will be encouraged to quit and if required we can signpost you to useful resources to help you.
More than half of current adult smokers in the UK (53%) say they want to quit and according to the ONS, the figures are moving in the right direction (down from 14.7% of the population in 2018 to 14.1% in 2019). Undergoing surgery offers one of the best possible incentives to give up smoking which will benefit not only your post-surgical recovery but your overall health in general.
Talk to an orthopaedic consultant | Cambridge
Please be reassured that despite the ongoing UK Covid-19 pandemic, types of orthopaedic treatments are now again being routinely offered to patients. Having the vaccine does not mean that your treatment won’t go ahead. However, in some circumstances, such as for planned surgery, it is advisable to delay it by a couple of weeks to ensure your body responds in the optimum way to the vaccine. If in doubt, please talk to your orthopaedic consultant or contact us for more guidance to help get your orthopaedic treatment back on track.
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