Outcomes in smokers and alcohol users after fast‐track hip and knee arthroplasty. Issue 5 (20th February 2013)

• Record Type: Journal Article
• Authors: JØRGENSEN, C. C; KEHLET, H.
• Is Part Of: Acta anaesthesiologica scandinavica. Volume 57:Issue 5(2013:May)
• Page Start: 631
• Page End: 638
• Publication Date: 2013-02-20
• Subjects: Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; 617.9605
• DOI: 10.1111/aas.12086
• Languages: English
• ISSNs: 0001-5172

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="aas12086-sec-0001" sec-type="section"> <title>Background</title> <p>Smoking and alcohol use impair post‐operative outcomes. However, no studies include fast‐track surgery, which is a multimodal‐enhanced recovery programme demonstrated to improve outcome. We hypothesised that outcome is similar in smokers and alcohol users as in non‐users after fast‐track hip and knee arthroplasty.</p> </sec> <sec id="aas12086-sec-0002" sec-type="section"> <title>Methods</title> <p>Prospective questionnaires on co‐morbidity and smoking/alcohol use were cross‐referenced with the Danish National Health Registry to investigate relationship between smoking/alcohol use and length of stay of > 4 days and readmissions ≤ 90 days after fast‐track hip and knee arthroplasty.</p> </sec> <sec id="aas12086-sec-0003" sec-type="section"> <title>Results</title> <p>In 3041 consecutive patients, 458 reported smoking and 216 drinking > 2 drinks a day, of which 66 did both. Smokers/alcohol users were younger than non‐users (mean age: 64.3 vs. 68.0 years, <italic>P</italic> < 0.001). Multiple regression analysis showed no relation between length of stay of > 4 days and smoking (odds ratio [95% confidence interval], <italic>P</italic>) (1.34 [0.92–1.95], 0.127) or alcohol use (0.59 [0.30–1.16], 0.127). Thirty‐ and ninety‐day readmission rate was 6.6% (<italic>n</italic> = 201) and 9.4% (<italic>n</italic> = 285). Multiple logistic regression analysis showed an increased risk of readmissions in smokers at 30 (1.60 [1.05–2.44], 0.028) but not 90‐day follow‐up (1.17 [0.80–1.73], 0.419). No increased risk of readmissions was found in alcohol users at 30 (0.94 [0.50–1.76], 0.838) or 90‐day follow‐up (0.83 [0.47–1.49], 0.532). No increased risk of specific readmissions (i.e. wound infections or pneumonia) typically related to smoking/alcohol use was found in smokers (1.56 [0.93–2.62], 0.091) or alcohol users (1.00 [0.47–2.15], 0.999) at 90‐day follow‐up.</p> </sec> <sec id="aas12086-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Influence of smoking or alcohol use may be less pronounced in fast‐track hip and knee arthroplasty compared with data with conventional care programmes.</p> </sec> </abstract>