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Outcomes in smokers and alcohol users after fast‐track hip and knee arthroplasty
Author(s) -
JØRGENSEN C. C,
KEHLET H.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12086
Subject(s) - medicine , confidence interval , odds ratio , fast track , logistic regression , alcohol , prospective cohort study , arthroplasty , physical therapy , surgery , biochemistry , chemistry
Background 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. Methods Prospective questionnaires on co‐morbidity and smoking/alcohol use were cross‐referenced with the D anish N ational H ealth R egistry 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. Results I n 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, P < 0.001). Multiple regression analysis showed no relation between length of stay of > 4 days and smoking (odds ratio [95% confidence interval], P ) (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% ( n = 201) and 9.4% ( n = 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). N o 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. Conclusion Influence of smoking or alcohol use may be less pronounced in fast‐track hip and knee arthroplasty compared with data with conventional care programmes.