SLR - October 2012 - Kristy A. Muscatello
Reference: Nasell, H., Ottosson, C., Tournqvist, H., Linde J., & Ponzer, S. (2011). The Impact of Smoking on Complications After Operatively Treated Ankle Fractures- A Follow-Up Study of 906 Patients. The Journal of Orthopedic Trauma, 748-755.
Scientific Literature Review
Reviewed by: Kristy A. Muscatello, DPM
Residency Program: INOVA Fairfax Hospital- Falls Church, VA
Podiatric Relevance:
Smoking has been shown to increase the postoperative complication rate by way of impairing the oxygen distribution to soft tissues, which has a negative impact on the immune response and tissue regeneration. Deep wound infections are a major concern, especially after reconstructive surgery for trauma to the lower extremity. The aim of this study was to investigate the impact of smoking on postoperative complications, particularly deep wound infections, in operatively treated ankle fractures.
Methods:
Nine hundred and six patients, 15 years or older, who were treated operatively (between March 1998 and February 2001) for acute ankle fractures with ORIF were separated into a smoking group (N= 185) and a non-smoking group (N= 721). Medical records were examined to collect baseline data such as co-morbidities, surgical intervention, and quality of fracture reduction. All patients were asked to fill out a questionnaire and return it six weeks after ORIF. All postoperative complications were recorded and verified with medical records. Additional follow-up after the first postoperative six weeks was also conducted until June 2002 and those with deep infections were followed until 2009. The smoking group was compared to the non-smoking group.
Results:
Of the smokers, 30.5 percent had at least one postoperative complication compared with 20.3 percent of the nonsmokers. The smokers also had a higher rate of outpatient visits compared with nonsmokers (mean, 4.3 and 3.5 visits, respectively). Four-point-nine percent of the smokers had a deep infection compared with 0.8 percent of the nonsmokers. Fourteen-point-eight percent of smokers compared with 9.7 percent of non-smokers developed superficial wound infections.
Conclusions:
The results reported in this study demonstrate that postoperative complications including postoperative wound infections were generally more common among smokers; underlining the importance of smoking as a risk factor for complications after ankle fracture ORIF.