Current tobacco use linked with increased pain, narcotic use after total shoulder arthroplasty

Results published in the Journal of Shoulder and Elbow Surgery showed increased pain and narcotic use among tobacco users following total shoulder arthroplasty.

Thomas W. Throckmorton, MD, and colleagues categorized 163 patients who underwent primary anatomic total shoulder arthroplasty for glenohumeral arthritis in groups as current tobacco users (n=28), nonusers (n=88) or former users (n=47).

Results showed significantly greater VAS scores preoperatively and at 12 weeks postoperatively among patients in the current tobacco use group vs. nonusers and former users. Researchers also found current tobacco users had a significantly lower mean improvement in VAS scores.

Patients in the current tobacco use group had significantly greater cumulative oral morphine equivalent use at 12 weeks postoperatively, as well as significantly greater average oral morphine equivalent per day. Researchers found no significant differences in length of stay or complications among groups.

“Not only does tobacco use negatively impact ultimate outcome after shoulder replacement, which is already known, but it is also associated with a more difficult postoperative course,” Throckmorton told Healio.com/Orthopedics. “We believe these data can help shoulder arthroplasty surgeons counsel patients regarding the reasonable expectations they may have for recovery following shoulder replacement. Further, as payment models are increasingly linked to 90-day outcomes, complications and use of perioperative resources, these data are relevant in the evolution of bundled payment plans. Finally, we note that tobacco is a modifiable risk factor, as patients who quit smoking can expect a similar recovery as patients who have never smoked.” – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.

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Source:

Wells DB, et al. J Shoulder Elbow Surg. 2018;doi:10.1016/j.jse.2017.06.033.