Tobacco use predicts poorer clinical outcomes and higher post-operative complication rates after open elbow arthrolysis
- 25 Downloads
Tobacco use is a worldwide public health problem, and has been found to be a predisposing factor for adverse functional outcomes and increased postoperative complication rates after various orthopedic operations. The purpose of this study was to determine the potential impact of tobacco use on open arthrolysis for post-traumatic elbow stiffness.
Materials and methods
A database search identified 145 patients with open arthrolysis performed for post-traumatic elbow stiffness; these were divided into three groups: current tobacco users (37), former users (28), and nonusers (80). All surgeries were performed using the same technique by the same doctor. General patient data, functional performance, and complications were documented and analyzed.
Demographic data and disease characteristics were comparable at baseline. Postoperatively, significant differences were found among the three groups in terms of range of motion (P < 0.001), Mayo Elbow Performance Score (P = 0.006), visual analog scale score for pain (P = 0.015), Dellon classification for ulnar nerve symptoms (P = 0.013), and total complication rates (P < 0.001). The current tobacco users group had the poorest clinical outcomes and highest complication rates, while no significant differences were found between former users and nonusers.
Current tobacco users reported increased risk of poorer clinical outcomes and higher postoperative complication rates after open arthrolysis. Former users were found to have outcomes similar to those of nonusers. This study underlines the importance of discontinuing tobacco use for patients with post-traumatic elbow stiffness who are considering open arthrolysis.
Level of evidence
Level III; Retrospective Cohort Design; Therapeutic Study.
KeywordsPost-traumatic elbow stiffness Open arthrolysis Tobacco use Clinical outcomes Complications
This study was supported by Project of Key Discipline Group of Shanghai Pudong New Area Health and Family Planning Commission (PWZxq2017-03), Three-year Action Plan of Clinical Skills and Innovation of Shanghai Hospital Development Center (16CR3029A), and Project of Medical Guidance of Foundation of Shanghai Committee of Science and Technology (17411966900).
Compliance with ethical standards
Conflict of interest
The authors declare no competing financial interests.
The Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital concluded that no approval was necessary for this study based on its retrospective design. Data were analyzed anonymously; all patients approved the publication of the results of this study by oral consent. The oral consent approval was documented in the patients’ files. This was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. All clinical investigations were conducted in accordance with the guidelines of the Declaration of Helsinki.
- 3.Cai J, Liu J, Fan C (2015) Open arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chin J Reparative Reconstr Surg 29(7):826–830Google Scholar
- 8.Cederbye F, Norberg R (2008) WHO report on the global tobacco epidemic 2011: warning about the dangers of tobacco. Geneva Switzerland WHO 34(3):581–581Google Scholar
- 9.Green BN, Johnson CD, Snodgrass J, Smith M, Dunn AS (2016) Association between smoking and back pain in a cross-section of adult Americans. Cureus 8(9):e806Google Scholar
- 11.Hastings H 2nd, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10(3):417–437Google Scholar
- 17.Liu J, Chen S, Fan C (2018) Treatment of elbow joint stiffness by open release combined with distal radius fixation hinged external fixation. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chin J Reparative Reconstr Surg 32(2):134–138Google Scholar
- 26.Shin NR, Park JW, Lee IC et al (2017) Melatonin suppresses fibrotic responses induced by cigarette smoke via downregulation of TGF-beta1. Oncotarget 8(56):95692–95703Google Scholar