Impact of Smoking on Outcomes Following Knee and Shoulder Arthroscopy

Arthroscopy of the knee and shoulder are two of the most commonly performed orthopaedic surgeries. Optimization of modifiable risk factors such as smoking status is crucial for good outcomes. Approximately 15.5% of Americans smoke, and the prevalence of smoking is highest in males ages 25-64, a group which also encompasses the majority of patients undergoing arthroscopic procedures. The purpose of this study was to determine whether there is any association between preoperative smoking and perioperative and early postoperative complications in a large population following shoulder and knee arthroscopic surgery. The National Surgical Quality Improvement Program (NSQIP) database was queried retrospectively for patients who underwent knee or shoulder arthroscopic sports medicine procedures between 2010-2016. These patients were identified using the current procedural terminology (CPT) codes. Deaths and complications recorded in the first 30 days postoperatively were included. Complications were categorized as cardiac, renal, wound (including all surgical site infections), sepsis, thromboembolic, or pulmonary. A composite outcome was defined as a patient experiencing any of the above complications. Univariate and multivariate analyses were performed examining associations between preoperative smoking and any of the complications individually or for the composite outcome. 134,822 cases were included in the study. In univariate analysis, smoking was associated with increased rates of complication in knee arthroscopy with the following: ACL reconstruction or medial and lateral meniscectomy, and shoulder arthroscopy with the following: debridement, decompression, or rotator cuff repair. Multivariate analysis, demonstrated that smoking was an independent risk factor for any complication/mortality event in shoulder arthroscopy with decompression (OR=1.46; 95% CI: 1.030-2.075), or debridement (OR=1.933; 95% CI: 1.211-3.084) and knee arthroscopy with medial and lateral meniscectomy (OR=1.97, 95% CI:1.407-2.757). Preoperative smoking is an independent risk factor for complications after several arthroscopic procedures, though with variability between types of procedure. In our study, patients who smoked were significantly younger, and presumably healthier, which may account for some of this variability. Advantages of the NSQIP database are high reliability, national validation, and a large sample size. Limitations include the retrospective nature of the study, lack of data on surgical technique and simultaneous procedures, and self-reporting of smoking status. Our data highlights that even in generally low-risk arthroscopic procedures, smoking may increase the risk of serious perioperative and early-postoperative complications, and adds to the evidence base regarding the dangers of smoking in orthopaedic surgery patients