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Journal Articles Orthopaedics & Traumatology: Surgery & Research Year : 2022

Impact of smoking cessation on healing after foot and ankle surgery


INTRODUCTION: Perioperative smoking is the main risk factor for the development of postoperative cutaneous wound healing complications. We require that all patients undergoing elective foot and ankle surgery stop smoking (6 weeks before and 3 months after) and this abstinence is monitored with a preoperative cotinine test. We therefore wanted to understand how this impacted wound healing in elective foot and ankle surgery: do wounds heal differently in patients who quit smoking for surgery, former smokers and nonsmokers? HYPOTHESIS: Our hypothesis was that patients who stopped smoking for an upcoming surgery had the same wound healing complications as nonsmokers and former smokers.MATERIALS AND METHODS: This was a historical, single-center, single-surgeon cohort study of adult patients who underwent an elective ankle or foot surgery between June2016 and July2017. Patients were divided into 3 groups: group 1 smokers who stopped for surgery, group2 former smokers, and group3 nonsmokers. The primary endpoint was the occurrence of wound healing complications during the wound care consult scheduled 3 weeks after surgery. RESULTS: A total of 256 patients with a mean age of 58±14.2 years (range, 18-88) were included. Group3 had more women and a lower BMI than the other groups, but all the other demographic characteristics were similar. Smoking cessation was achieved in group1 on average 2.5±1.3 months (range, 1-6) before surgery. There were a total of 20 wound healing complications or 7.5% of the cohort: 13% in group1, 11.1% in group2 and 6.4% in group3. The univariate analysis found that the odds ratio was 2.3 when comparing Group1 to Group3 and 1.85 when comparing group2 to group3 (p=413). No significant risk factors for wound healing complications were found.DISCUSSION/CONCLUSION: Smoking cessation for foot and ankle surgery seems to limit the risk of wound healing complications, with results close to those of former smokers and nonsmokers. Mandatory smoking cessation before surgery could be one of the solutions to prevent this frequent complication. LEVEL OF EVIDENCE: III.

Dates and versions

hal-04050371 , version 1 (29-03-2023)



Anouk Rozinthe, Quentin Ode, Fabien Subtil, Michel-Henri Fessy, Jean-Luc Besse. Impact of smoking cessation on healing after foot and ankle surgery. Orthopaedics & Traumatology: Surgery & Research, 2022, 108 (7), pp.103338. ⟨10.1016/j.otsr.2022.103338⟩. ⟨hal-04050371⟩
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