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Lightening Up the Smokes Eases OR Recovery

Bone-joint patients heal faster by cutting tobacco intake ahead of operation

THURSDAY, Jan. 10, 2002 (HealthDayNews) -- Smokers facing elective surgery on bone joints heal better and recover faster if they quit or cut down their tobacco intake several weeks before the operation, a new study says.

Researchers in Denmark, who studied smokers undergoing hip and knee replacements, found that those who tried to quit six to eight weeks before surgery had fewer wound complications and a lower risk of cardiovascular trouble after the procedures. They also spent fewer days in the hospital recovering than did full-bore smokers, according to the study, which appears this week in the journal The Lancet.

"How short-term smoking cessation influences wound healing has not been shown clinically, but experimental data suggest that even a few days [off tobacco] could improve tissue blood flow and oxygenation, so it might very well have a positive effect on wound healing," Dr. Ann Møller, lead author of the study, said in an e-mail interview.

While other researchers have found that smoking impedes wound healing, the latest work is the first randomized trial to look at the impact of smoking cessation programs on post-operative outcomes, Møller said.

Møller, an anesthesiologist at Bispebjerg University Hospital in Copenhagen, and her colleagues followed 120 smokers scheduled for hip and knee replacement surgery.

Half of the smokers were told to stop, or to cut their cigarette intake by at least 50 percent, starting six to eight weeks before the operation. They were encouraged to do so with counseling and nicotine replacement, such as the patch. The rest of the smokers were allowed to continue smoking. All the smokers, who were typically in their mid-60s, reported puffing an average of 15 cigarettes a day before entering the study.

Of the men and women in the smoking cessation group, 36 managed to quit smoking, 14 cut their tobacco intake and six continued smoking. Only four of the people in the second group quit smoking before surgery, while the rest did not alter their tobacco intake significantly. Eight patients whose operations were delayed or canceled were dropped from the study.

Ten patients in the smoking cessation group, or 18 percent, suffered complications after surgery, compared with 52 percent of those in the second group, the researchers say. These complications included infections and bruising at the surgical site, urinary tract infections and gastric bleeding.

The difference was particularly marked for wound-related trouble, which occurred in only 5 percent of the stopped smokers, compared to 31 percent of those who did not stop.

None of the patients in the no-smoking group suffered a cardiovascular setback, while 5 people, or 10 percent, in the other group did.

"This doesn't mean that quitters cannot have complications, but that it will happen less often," Møller said.

Patients who received smoking-cessation therapy were also about 75 percent less likely to require additional surgery to correct problems with the initial procedure. And they spent less recuperation time in the hospital -- 11 days vs. 13 days.

Møller said the study shows that the effects of smoking on recovery are reversible, and that smoking-cessation therapy prior to surgery is "an intervention that gives us a major reduction in postoperative complications, patient suffering and, presumably, in health care costs."

Orthopedic surgeons say long lead times for elective procedures like joint operations offer a good opportunity for doctors to encourage their patients to quit smoking.

"Even [quitting] for a few weeks, you will see positive effects, but the longer the better," said Dr. Stuart Hirsch, chairman of the department of orthopedics at Somerset Medical Center in Somerville, N.J., and a member of the board of directors of the American Academy of Orthopaedic Surgeons.

Not only does smoking undermine tissue and vessel health, it weakens the bone mineral that keeps the skeleton strong, Hirsch said.

"It is a worthwhile effort to say to your patient, 'Stop smoking,' " Hirsch said. "What you want to do is partner with your patients for the very best result. If the patient doesn't do everything that he or she should do to get the very best result, they're going to be disappointed."

What to Do: For more on smoking's impact on surgery and recovery, try To learn more about how to quit smoking, check out the Office of the Surgeon General, QuitNet, or the American Lung Association.

SOURCES: Interviews with Ann Møller, M.D., senior researcher, department of anesthesiology, Bispebjerg University Hospital, Copenhagen, Denmark; Stuart A. Hirsch, M.D., chairman, department of orthopedics, Somerset Medical Center, Somerville, N.J.; Jan. 12, 2002, The Lancet
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