The Effect of Preoperative Smoking Status on Outcomes Following TAA

Submission Type: Total Ankle Arthroplasty Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: With total ankle arthroplasty (TAA) emerging as an increasingly prevalent treatment for advanced ankle arthritis, continual reevaluation of patient factors that may influence postoperative outcomes is critical. In other disciplines of orthopaedic surgery, the current evidence associating smoking with increased rates of poor wound healing, infection, and functional outcomes is robust. However, in TAA, the literature remains relatively sparse and inconclusive. This study aims to address this gap by comprehensively analyzing the impact of preoperative smoking on the outcomes of TAA. Methods: The Nationwide Readmissions Database (NRD) was queried from 2016 to 2020 to identify 29,705 patients undergoing primary elective TAA. Patients were divided into two cohorts based on their preoperative smoking status, with 7,526 (25.3%) being active smokers at the time of surgery. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to identify independent predictors of postoperative outcomes other than preoperative smoking status. Results: The cohort was mostly male (54.2%) with mean age of 65.14 (range 17-90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0-12). Active smokers were significantly older (Smoker = 66.75, Nonsmoker = 64.6; p < .001), more likely to be male (Smoker = 58.81%, nonsmoker = 52.66%; p < .001), and had higher rates of comorbidity as measured by CCI score (Smoker = 0.79, Nonsmoker = 0.60; p < .001). Multivariable regression showed that preoperative active smoking was predictive of increased risk of intraoperative or postoperative bleeding (Odds Ratio [OR] = 5.309, p = .001), readmission (OR = 1.149; p = .002), and adverse discharge (OR = 1.067; p = .039). This analysis found active smokers to be at a decreased risk of sepsis (OR = 0.163; p = .006) and ARF (OR = 0.451; p < .001). Additionally, it was found that preoperative active smoking status was significantly predictive of over a $400 increase in total cost of admission (b = 412.51; p = .029). Conclusion: Active smokers undergoing total ankle arthroplasty face a higher risk of intraoperative or postoperative bleeding, readmission, and adverse discharge compared to non-smoking patients. They also incur greater healthcare costs. Interestingly, active smokers have a lower risk of sepsis and acute renal failure, signaling potential areas for future research.