Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking cessation program, initiated during the acute hospitalization period and carried out for six weeks, could reduce the number of complications following emergency surgical treatment of fractures.
In a multicenter, single-blinded, randomized, controlled clinical trial, 105 smokers with a fracture of the lower or upper extremity that needed acute surgical treatment were randomized to an intervention group (n = 50) or a control group (n = 55). The intervention group was offered a standardized smoking cessation program for six weeks, and all patients were followed at two to three weeks, four weeks, and six to twelve weeks.
The proportion of patients with at least one postoperative complication was significantly larger in the control group than it was in the intervention group (38% and 20%, respectively; p = 0.048). The development of two or more postoperative complications was also more common among the controls (p = 0.039). The rates of superficial wound infection, the most frequently recorded complication in both groups, were 20% and 8%, but this difference was not significant. A secondary analysis showed that the odds of having a complication were 2.51 times (95% confidence interval, 0.96 to 6.9 times) higher in the control group than in the intervention group, but this difference was not significant.
Our results indicate that a smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications.
[Show abstract][Hide abstract] ABSTRACT: Smoking is a well-known risk factor for complications after surgery. Studies of interventions to encourage smokers to stop smoking before their operation show that short- and long-term quitting can be achieved. Evidence from two small trials indicates that interventions that begin four to eight weeks before surgery, which include weekly counselling and use NRT, support smoking cessation and may reduce complication rates. Brief interventions support short-term smoking cessation but there is insufficient evidence from this review to determine whether they reduce complications. This may be due to the longer period of pre-operative abstinence that can be achieved when interventions begin four to eight weeks before surgery.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Spotting rates of up to 25% have been
reported after supracervical hysterectomy.We report
here on our stump infection and spotting
rates after standard laparoscopically assisted
supracervical hysterectomy (LASH) and LASH
with additional laparoscopic excision of the cervical
Material and Methods: 260 premenopausal patients
underwent LASH at our institution between
January 2006 and June 2009. Until July
2007 we performed straight dissection of the cervix
and coagulated the remaining cervical channel
(LASH). Since July 2007 we dissected the cervical
channel laparoscopically and coagulated the
remaining cervical channel (eLash). All patients
were asked to fill in a questionnaire on the spotting
rate, postoperative infections and smoking
Results: We had a response rate of 70% (n = 183).
88 patients of the LASH group and 85 patients of
the eLASH group completed the questionnaire.
Nine patients did not fill in the questionnaire
completely. 21.6% (19/88) of the LASH group and
5.9% (5/85) of the eLASH group reported spotting
continuing for more than one year after operation
(p = 0.004). The postoperative rate of stump infections
was 6.8% (6/88) in the LASH group and 5.9%
(5/85) in the eLASH group (p = 0.999). There was
a slight tendency towards increased infection
rates in smokers (9.4% [5/53] vs. 5% [6/120],
p = 0.315).
Conclusion: Laparoscopic excision of the cervical
channel seems to reduce the spotting rate. The
stump infection rate is moderate and comparable
to that after LASH.
Geburtshilfe und Frauenheilkunde 07/2010; 2010(70):798–802. DOI:10.1055/s-0030-1250399 · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A retrospective study of 30 patients (12 alcoholics and 18 nonalcoholics) was performed to determine whether the fracture healing time (T) was longer in alcoholics and smokers. Fracture healing time (mean ± standard error) was longer in alcoholics (24.1 ± 5.8 weeks vs. 11.4 ±1.1 weeks in nonalcoholics, p=0.001) and in 21 smokers (15.8 ± 2.9 weeks) vs. 9 nonsmokers (18.2 ± 5.9 weeks) (p=0.045). Delayed union, defined as T > 26 weeks, was more prevalent in alcoholics (4 out of 12) than in nonalcoholics (0 out of 18) (p = 0.018). Experimental evidence from fracture healing studies in ethanol-fed rats indicates that ethanol adversely affects the early stages of fracture healing. Findings in this preliminary study are consistent with this hypothesis, but are based on small number of patients. Nevertheless, they suggest that standard orthopedic treatments may not be sufficient to prevent delay of fracture healing in alcoholics.
Roman Sosnowski, Paolo Verze, Cosimo De Nunzio, Marc A Bjurlin
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