Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively

Table 1 Basic demographics, n (%)

Parameter	Overall cohort	Relapsed postop	Abstinent postop	P value
Number of patients	37	21	16
Total knee replacement	17 (45.9)	12 (57.1)	5 (31.2)	0.22
Average age in yr (SD)	60.62 (11.90)	62.76 (12.32)	57.81 (11.08)	0.22
Male	15 (40.5)	9 (42.9)	6 (37.5)	1.00
Race				0.62
African American	10 (27.0)	5 (23.8)	5 (31.2)
Caucasian	26 (70.3)	15 (71.4)	11 (68.8)
Other	1 (2.7)	1 (4.8)	0 (0.0)
Marital status				0.36
Divorced	6 (16.2)	5 (23.8)	1 (6.2)
Married	21 (56.8)	10 (47.6)	11 (68.8)
Single	9 (24.3)	5 (23.8)	4 (25.0)
Widowed	1 (2.7)	1 (4.8)	0 (0.0)
Average BMI (SD)	29.96 (6.86)	30.53 (6.75)	29.20 (7.17)	0.58
Average ASA (SD)	2.43 (0.55)	2.52 (0.60)	2.31 (0.48)	0.26
Hospital LOS in d (SD)	2.76 (1.92)	2.90 (2.21)	2.56 (1.50)	0.6
Follow up mean (SD)	2.85 (1.93)	2.65 (2.20)	3.11 (1.53)	0.48

ASA: American Society of Anesthesiologist; BMI: Body mass index; LOS: Length of stay.

Table 2 Tobacco use information, n (%)

Parameter	Overall cohort	Relapsed postop	Abstinent postop	P value
Number of patients	37	21	16
Tobacco use preoperatively				0.66
Cigarettes	32 (86.5)	18 (85.7)	14 (87.5)
Cigars	4 (10.8)	2 (9.5)	2 (12.5)
Other	1 (2.7)	1 (4.8)	0 (0.0)
Provider requested tobacco abstinence preoperatively				0.34
Yes	31 (83.8)	19 (90.5)	12 (75.0)
No	5 (13.5)	2 (9.5)	3 (18.8)
Can't remember	1 (2.7)	0 (0.0)	1 (6.2)
PPD prior to cessation efforts (SD)	0.74 (0.52)	0.80 (0.55)	0.68 (0.48)	0.51
Complete tobacco abstinence preoperatively	27 (73.0)	15 (71.4)	12 (75.0)	1.00
PPD preoperatively after cessation efforts	0.06 (0.12)	0.08 (0.14)	0.04 (0.10)	0.49
Time until tobacco relapse in mo (SD)	2.73 (1.82)	2.73 (1.82)	Not Applicable
Cessation method				0.55
Nothing	24 (64.9)	12 (57.1)	12 (75.0)
Prescription medication
Varenicline	2 (5.4)	2 (9.5)	0 (0.0)
Bupropion	3 (8.1)	1 (4.8)	2 (12.5)
Nicotine replacement	7 (18.9)	6 (28.6)	1 (6.2)
Counseling	2 (5.4)	2 (9.5)	0 (0.0)
Gum or mints	2 (5.4)	0 (0.0)	2 (12.5)
Current tobacco use	19 (51.4)	19 (90.5)	0 (0.0)	< 0.01
Tobacco use at some point postoperatively	2 (5.4)	2 (9.5)	0 (0.0)	0.59
Average PPD (SD)	0.24 (0.35)	0.44 (0.37)	0.00 (0.00)	< 0.01
Reported complication postoperatively				0.36
SSI	1(2.7)	0 (0.0)	1 (6.2)
Dislocation	1(2.7)	1 (4.8)	0 (0.0)
PJI	0 (0.0)	0 (0.0)	0 (0.0)
Revision surgery	0 (0.0)	0 (0.0)	0 (0.0)

PJI: Prosthetic joint infections; PPD: Packs per day; SSI: Surgical site infection.

Table 3 Patient reported outcome scores

Outcome score	Overall cohort	Relapsed postop	Abstinent postop	P value
Number of patients	37	21	16
Promis-10 physical function score, Mean (SD)	46.35 (9.25)	44.12 (9.52)	49.27 (8.27)	0.09
Promis-10 mental health score, Mean (SD)	52.56 (10.60)	48.58 (11.65)	57.79 (6.12)	< 0.01
KOOS. JR, Mean (SD)	80.77 (17.58)	78.36 (19.88)	86.56 (9.52)	0.4
HOOS. JR, Mean (SD)	73.53 (18.02)	63.12 (8.23)	82.05 (19.63)	0.02

KOOS. JR: Knee injury and osteoarthritis outcome score for joint replacement; HOOS. JR: Hip dysfunction and osteoarthritis outcome score for joint replacement.