Injured smokers experience longer delays for orthopedic consultations

NICE — Patients who smoke often receive a lower standard of care than nonsmokers, and many experience longer delays in seeing an orthopedic surgeon for treatment, according to a report presented here.

Why smokers receive a lower standard of care may be the result of several factors, said Dominique Rouleau, MD, of Montreal, who presented results at the 9th European Federation of National Associations of Orthopaedics and Traumatology Congress, here.

The researchers enrolled and followed all ambulatory patients with an isolated extremity injury referred to one orthopedic trauma clinic. They compared data on the type of trauma, prior medical consultations, quality of initial management, patient characteristics and smoking status.

Among 166 consecutive patients referred, 45 were smokers.

Forty-four percent of smokers had a family income under $30,000, compared to 27% of nonsmokers, Rouleau said. Likewise, smokers were typically younger than nonsmokers (43 years old vs. 50 years old, respectively) and used illegal drugs more often (16% vs. 5%, respectively).

Smokers were also more likely to have been injured at work, while nonsmokers reported their injury as a sport accident, according to the abstract.

Injury severity, type of injury and ethnic characteristics were similar among the groups, she said.

Smokers were twice as likely to receive an unacceptable recommendation for immobilization because of their injury as nonsmokers (52% vs. 25%, respectively), and a greater percentage of smoking patients received inadequate walking aids compared to their nonsmoking counterparts (26% vs. 9%).

The time duration between the first primary care consultation and the first orthopedic appointment was almost two times longer for smokers (93 hours vs. 58 hours, respectively).

“The primary care quality and efficiency were associated with smoking status, possibly due to medical bias or because smokers took longer to see their doctor for follow-up,” Rouleau said. “Smoking has always been a risk factor for some complications in orthopedic surgery, and our results suggest that biology may not be the only explanation.”

For more information:
Rouleau D, Feldman D, Parent S. Discrimination in access to injured smokers? Paper F312. Presented at the 9th European Federation of National Associations of Orthopaedics and Traumatology Congress. May 29-June 1, 2008. Nice.