98.
Outcomes in tobacco and alcohol users after fast-track hip- and knee
replacement.
Calov Joergensen Christoffer , Kehlet Henrik
Section for Surgical Pathophysiology 4074 Rigshospitalet 2200 Copenhagen
Ø; Section for Surgical Pathophysiology 4074, Rigshospitalet 2200
Copenhagen Ø
Background:
Several studies have shown smoking and alcohol use to impair
postoperative outcome, including after total hip- (THA) and kneearthroplasty
(
TKA). However, no studies are on fast-track surgery, which has been
demonstrated to improve postoperative outcome
Purpose / Aim of Study:
To evaluate the risk of prolonged length of hospital
stay (LOS) and readmissions in smokers/alcohol users receving fast track
primary elective THA/TKA.
Materials and Methods:
Patients from 5 wards of the Lundbeck Foundation
Centre for fast-track THA and TKA, prospectively completed questionnaires
on co-morbidity and smoking/alcohol use. These were cross- referenced with
the Danish National Health registry, medical charts and the Central Office of
Civil Registration on LOS, readmissions and mortality.
Findings / Results:
In 3041 patients, 608 reported to be smoking (n=458) or
having more than 2 drinks a day (n=216). Smokers/alcohol users were
generally male, younger (mean age 64.2 vs. 68.0 yrs), had lower Body Mass
Index (mean 27.9 vs 28.5) and shorter LOS (median 2 vs 3 days) than non-
users. Multiple regression showed a non-significant increased risk of LOS >4
days when smoking (OR: 1.34 95%CI:[0.74-1.95] p=0.13) but not when using
alcohol (OR: 0.59 95%CI: [0.30-1.16] p=0.13). Readmissionrate was 6.6% and
9.4%
in 30 and 90 days. Smoking was related to readmissions in 30 (OR: 1.60
95%
CI:[1.05-2.44] p<0.05) but not 90 days (OR: 1.17 95%CI:[0.80- 1.73]
p=0.42). Alcohol use was unrelated to readmissions in 30 (OR:0.94
95%
CI:[0.50-1.76] p=0.84) and 90 days (OR: 0.85 95%CI:[0.47-1.52]
p=0.58).
Conclusions:
There was no increase in LOS with smoking/alcohol use.
Smokers had increased risk of readmission in 30 but not 90 days. The
influence of smoking or alcohol use may be less pronounced in patients
undergoing fast-track surgery compared to previously shown in conventional
care programs.
