Smoking increases complication rates following acute ankle fracture

Nasell H. J Orthop Trauma. 2011. doi: 10.1097/BOT.0b013e318213f217.

Smoking can increase postoperative complication risk in patients operatively treated for acute ankle fractures, according to this study from Swedish researchers.

The team performed a cohort study with prospective follow-up on a consecutive series of 906 patients who underwent operative treatment for an acute ankle fracture during a 3 year period. The patients were separated into two categories: smokers (185) and non-smokers (721). Investigators collected data on the patients through a departmental database and conducted a review of medical charts.

With 6-week follow-up data available for 98.2% of patients, the authors found a 30.1% postoperative complication rate in smokers and a 20.3% postoperative complication rate in non-smokers. Furthermore, deep wound infections were statistically significantly more common in smokers (4.9%) than non-smokers (0.8%).

Investigators also found enhanced risks of postoperative complications in both cohorts in the presence of complicated fractures, associated diabetes mellitus or insufficient operative reductions.

“Smoking is a considerable risk factor,” the authors wrote. “Therefore, physicians, nurses, and other healthcare professionals should strive to support patients to stop smoking while still under acute treatment.”

Smoking has been shown in this current study to increase the risk of postoperative complications for acute ankle fractures.

Other randomized studies have also shown smokers to be at higher risk of cardiopulmonary and wound-related postoperative complications, including deep infections and the need for post-operative intensive care. Smoking intervention, including counseling, nicotine replacement therapy and smoking cessation, is recommended in patient undergoing all types of surgery, including orthopedic procedures.

Although there is no optimal smoking cessation period before surgery, cessation of only 6 weeks has been noted to decrease the risk of complications. In addition, evidence indicates that longer periods of smoking cessation decrease the incidence of postoperative complications even more than short periods.

— Carol Frey, MD
Assistant Clinical Professor, Orthopedic Surgery
Co-Director, Sports Medicine Fellowship
West Coast Sports Medicine Foundation
Manhattan Beach, CA