Let us start by saying – this article will not be a lecture from atop a high horse. People still smoke for a variety of reasons, and the choice is theirs. We commend those that have tried and successfully quit, regardless of why they chose to do so. We respect how difficult it is to quit, and recognize many people try multiple times to do so. We acknowledge that some people don’t want to quit smoking, and we are not here to twist their arm.

There are many health reasons to quit smoking. Grab a pamphlet at any doctor’s office and it will tell you how quitting will prevent heart attacks, or strokes, or emphysema, or cancer. All those are great, but we not experts in any of those things. The reason busy orthopedic surgeons are writing about smoking cessation is that it makes a difference to your bones, joints and muscles. It makes a difference If we are managing your fractures, or talking to you about a surgery. It makes a difference in your outcomes of the treatments we recommend or the surgeries we perform on you.

Here are the only statistics we will put in this article:

  • Smokers are 30% more likely to have any post-operative infection and six times more likely to have a wound infection when compared to non-smokers.
  • Smokers have a 40% chance of having a breathing problem after surgery, compared to 11% in those that do not smoke.
  • Smoking inhibits bone growth and is the major preventable cause of bone non-union (inability of a fracture to heal).
  • Smoking negatively impacts success of bone fusion procedures (common in the foot and ankle).
  • Smoking predicts negative results in those undergoing knee ligament repair, rotator cuff repair, total knee arthroplasty, total hip arthroplasty, and fracture surgery.
  • Smokers are 38% more likely to die after surgery than patients who have never smoked.

Stats are all done.  If you skimmed over them the following sentence applies to nearly every orthopaedic surgery or injury: Smoking impedes healing, delays return to function, increases infection and complication risk, and may predict failure of surgery.

We will never make life choices for you, but we would be doing you a disservice by not stating the above. In some cases, such as fusion surgery of the foot and ankle, we may delay surgery because the results are so poor in smokers. Beyond that, we can only be there to help if surgery does not go as planned. But if you are so inclined, you can help increase the chance that surgery does go well – by quitting. You can speak to your family physician. You can seek information from trusted websites (www.stopsmokingforsafersurgery.ca or www.smokershelpline.ca to name a few). You can ask the help of family and friends to keep you honest and give you support. You can ask us, and we will provide whatever help we can.

Many people joke that it is only a matter of time before you will be sitting in the clinic of an Orthopaedic surgeon.  As surgeons, we want the best outcomes for our patients. There are many things in our control which we use to give a patient the best shot – following treatment guidelines, meticulous surgical technique, multi-modal and multi-disciplinary care, and asking for the help of colleagues when needed. It is humbling to know that smoking may have as great an impact as any one of those factors, and it is completely out of our control. The best we can do is get the word out, and thank those who take the time to listen – regardless of what they decide.

 

Yours in Health

Drs. Brent Mollon, Jerry Xing & Raaj Vora