Effect of Preoperative Smoking Intervention on Postoperative Complications of Total Hip Replacement_Chinese Journal of Evidence-Based Medicine

Authors：

 PEIHao , ZHANGLing-jie , ZENGLi-ming , YUFeng

Department of Anesthesiology, Hubei Xinhua Hospital, Wuhan 430015, China;

Corresponding author：

Keywords：

Smoking cessation; Total hip replacement; Postoperative complication; Randomized controlled trial

DOI：

10.7507/1672-2531.20140069

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Objective To investigate the effect of preoperative smoking intervention on the incidence of postoperative complication in patients undergoing total hip replacement. Methods Patients undergoing elective total hip replacement were randomly (block randomization) assigned to either smoking intervention group or control group 4 weeks before scheduled hip replacement. Smoking intervention group received counseling and nicotine replacement therapy and achieved smoking cessation or at least 50% smoking reduction while the control group received standard care with little or no information about the risk of smoking or smoking cessation counselling. Anesthesia was done in accordance with the practice of our hospital with either general anesthesia or combined spinal-epidural anesthesia (CSEA). An assessor who was masked to the intervention recorded the incidence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance and treatment in intensive care unit (ICU) of two groups of patients. Results A total of 120 patients were finally included (60 cases were in each group, all male, ASAⅠ-Ⅲ, aged 65-82 years, weighting 42-75 kg). A total of 56 patients in the smoking intervention group and 57 in the control group were analyzed finally. The results showed that, the smoking intervention group was lower than the control group in the incidences of post-operative complications (12/56 vs. 39/57, P=0.000), postoperative wound-related complications (3/56 vs. 21/57, P=0.000), incision infection (1/56 vs. 13/57, P=0.001), and the requirement of secondary surgery (1/56 vs. 9/57, P=0.022) and wound debridement (1/56 vs. 8/57, P=0.040). The median length of stay in the smoking intervention group was significantly less than that of the control group (14 days vs. 26 days, P=0.000). Conclusion An effective smoking intervention 4 weeks before surgery reduces incidence of postoperative complications.

Citation： PEIHao, ZHANGLing-jie, ZENGLi-ming, YUFeng. Effect of Preoperative Smoking Intervention on Postoperative Complications of Total Hip Replacement. Chinese Journal of Evidence-Based Medicine, 2014, 14(4): 399-403. doi: 10.7507/1672-2531.20140069 Copy

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2.	Bluman LG, Mosca L, Newman N, et al.Preoperative smoking habits and postoperative pulmonary complications.Chest, 1998, 113(4):883-889.
3.	Wetterslev J, Hansen EG, Kamp-Jensen M, et al.PaO₂ during anaesthesia and years of smoking predict late postoperative hypoxaemia and complications after upper abdominal surgery in patients without preoperative cardiopulmonary dysfunction.Acta Anaesthesiol Scand, 2000, 44(1):9-16.
4.	王莉, 喻佳洁, 成岚, 等.中国人群吸烟与卒中关系的Meta分析.中国循证医学杂志, 2010, 9(9):81-82.
5.	Otsuka R, Watanabe H, Hirata K, et al.Acute effects of passive smoking on the coronary circulation in healthy young adults.JAMA, 2001, 286(4):436-441.
6.	Sørensen LT, Hørby J, Friis E, et al.Smoking as a risk factor for wound healing and infection in breast cancer surgery.Eur J Surg Oncol, 2002, 28(8):815-820.
7.	Moller AM, Maaløe R, Pedersen T.Postoperative intensive care admittance:the role of tobacco smoking.Acta Anaesthesiol Scand, 2001, 45(3):345-348.
8.	孙振球, 主编.医学统计学.第2版.北京:人民卫生出版社, 2008:591-592.
9.	万霞, 刘建平.临床试验中的随机分组方法.中医杂志, 2007, 48(3):216-218.
10.	Meneses-Gaya IC, Zuardi AW, Loureiro SR, et al.Psychometric properties of the Fagerström Test for Nicotine Dependence.J Bras Pneumol, 2009, 35(1):73-82.
11.	Sørensen LT.Wound healing and infection in surgery.The clinical impact of smoking and smoking cessation:a systematic review and meta-analysis.Arch Surg, 2012, 147(4):373-383.
12.	Thomsen T, Tønnesen H, Møller AM.Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation.Br J Surg, 2009, 103(5):841-845.
13.	俞红霞, 林江涛.从循证医学角度分析各种戒烟方法的实际应用价值.国际呼吸杂志, 2006, 26(3):199-202.
14.	Ambrose JA, Barua RS, The pathophysiology of cigarette smoking and cardiovascular disease:An update.J Am Coll Cardiol, 2004, 43(10):1731-1737.
15.	Sørensen LT, Karlsmark T, Gottrup F.Abstinence from smoking reduces incisional wound infection:a randomized controlled trial.Ann Surg, 2003, 238(1):1-5.
16.	Guo S, DiPietro LA.Factors Affecting Wound Healing.J Dent R, 2010, 89(3):225-226.
17.	Lindström D, Azodi OS, Wladis A, et al.Effects of a perioperative smoking cessation intervention on postoperative complications:a randomized trial.Ann Surg, 2008, 248(5):739-745.
18.	Michioki K, Masashi N, Hideo T, et al.Determination of the Duration of Preoperative Smoking Cessation to Improve Wound Healing after Head and Neck Surgery.Anesthesiology, 2005, 102(5):892-896.
19.	Garcia-Aymerich J, Lange P, Benet M.Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 2007, 175(5):458-463.
20.	Wetterslev J, Hansen EG, Kamp-Jensen M, et al.PaO₂ during anaesthesia and years of smoking predict late postoperative hypoxaemia and complications after upper abdominal surgery in patients without preoperative cardiopulmonary dysfunction.Acta Anaesth Scand, 2000, 44(1):9-16.

1. Kuri M, Nakagawa M, Tanaka H, et al.Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery.Anesthesiology, 2005, 102(5):892-896.
2. Bluman LG, Mosca L, Newman N, et al.Preoperative smoking habits and postoperative pulmonary complications.Chest, 1998, 113(4):883-889.
3. Wetterslev J, Hansen EG, Kamp-Jensen M, et al.PaO₂ during anaesthesia and years of smoking predict late postoperative hypoxaemia and complications after upper abdominal surgery in patients without preoperative cardiopulmonary dysfunction.Acta Anaesthesiol Scand, 2000, 44(1):9-16.
4. 王莉, 喻佳洁, 成岚, 等.中国人群吸烟与卒中关系的Meta分析.中国循证医学杂志, 2010, 9(9):81-82.
5. Otsuka R, Watanabe H, Hirata K, et al.Acute effects of passive smoking on the coronary circulation in healthy young adults.JAMA, 2001, 286(4):436-441.
6. Sørensen LT, Hørby J, Friis E, et al.Smoking as a risk factor for wound healing and infection in breast cancer surgery.Eur J Surg Oncol, 2002, 28(8):815-820.
7. Moller AM, Maaløe R, Pedersen T.Postoperative intensive care admittance:the role of tobacco smoking.Acta Anaesthesiol Scand, 2001, 45(3):345-348.
8. 孙振球, 主编.医学统计学.第2版.北京:人民卫生出版社, 2008:591-592.
9. 万霞, 刘建平.临床试验中的随机分组方法.中医杂志, 2007, 48(3):216-218.
10. Meneses-Gaya IC, Zuardi AW, Loureiro SR, et al.Psychometric properties of the Fagerström Test for Nicotine Dependence.J Bras Pneumol, 2009, 35(1):73-82.
11. Sørensen LT.Wound healing and infection in surgery.The clinical impact of smoking and smoking cessation:a systematic review and meta-analysis.Arch Surg, 2012, 147(4):373-383.
12. Thomsen T, Tønnesen H, Møller AM.Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation.Br J Surg, 2009, 103(5):841-845.
13. 俞红霞, 林江涛.从循证医学角度分析各种戒烟方法的实际应用价值.国际呼吸杂志, 2006, 26(3):199-202.
14. Ambrose JA, Barua RS, The pathophysiology of cigarette smoking and cardiovascular disease:An update.J Am Coll Cardiol, 2004, 43(10):1731-1737.
15. Sørensen LT, Karlsmark T, Gottrup F.Abstinence from smoking reduces incisional wound infection:a randomized controlled trial.Ann Surg, 2003, 238(1):1-5.
16. Guo S, DiPietro LA.Factors Affecting Wound Healing.J Dent R, 2010, 89(3):225-226.
17. Lindström D, Azodi OS, Wladis A, et al.Effects of a perioperative smoking cessation intervention on postoperative complications:a randomized trial.Ann Surg, 2008, 248(5):739-745.
18. Michioki K, Masashi N, Hideo T, et al.Determination of the Duration of Preoperative Smoking Cessation to Improve Wound Healing after Head and Neck Surgery.Anesthesiology, 2005, 102(5):892-896.
19. Garcia-Aymerich J, Lange P, Benet M.Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 2007, 175(5):458-463.
20. Wetterslev J, Hansen EG, Kamp-Jensen M, et al.PaO₂ during anaesthesia and years of smoking predict late postoperative hypoxaemia and complications after upper abdominal surgery in patients without preoperative cardiopulmonary dysfunction.Acta Anaesth Scand, 2000, 44(1):9-16.

Chinese Journal of Evidence-Based Medicine

Effect of Preoperative Smoking Intervention on Postoperative Complications of Total Hip Replacement

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