Abstract
Smoking is associated with an increased risk of complications, higher opioid use,
and mortality following primary elective total hip arthroplasty (THA). Interventions
for smoking cessation have been enhanced since value-based care was initiated in 2013.
It remains unclear whether surgical optimization has influenced the proportion of
smokers undergoing THA over time. Our study examines trends in the yearly proportions
of smokers for primary elective THA versus patients having annual physical examinations
(APEs). We retrospectively reviewed all patients of 18 years of age or older who underwent
primary elective THA and those who had an APE at our institution between January 2012
and December 2021. The electronic medical record was queried for baseline demographics
and documented smoking status. Linear regression analysis was used to determine trend
significance. In total, 12,524 primary THA patients were matched in a 1:5 ratio to
62,630 APE patients using nearest-neighbor matching. Our analysis demonstrated significantly
higher proportions of documented current and former smokers within the THA group at
each time point compared with the APE group. The rate of current smokers undergoing
THA demonstrated a downward trend that was not significant. There was a significant
upward trend in documented current smokers presenting for an APE. Although there has
been a decrease in active smokers undergoing THA at our institution over the past
decade, this trend is not significant. Therefore, it remains unclear whether smoking
cessation interventions have influenced patients undergoing primary THA. Continued
vigilance in smoking cessation strategies is warranted, and improved documentation
of smoking status may enhance our current understanding of whether optimization efforts
are successful.
Level III Evidence Retrospective cohort study.
Keywords
smoking - total hip arthroplasty - value-based care - trends - optimization
