Smoking is a risk factor of organ/space surgical site infection in orthopaedic surgery with implant materials

In recent guidelines, smoking is reported as a factor increasing the risk of surgical site infection (SSI). The accurate analysis of the literature shows that this recommendation relies on low level of evidence in orthopaedic surgery with material implantation (arthroplasty components or implants for internal fixation). This study aimed to assess the attributable risk of smoking on organ/space SSI in orthopaedic surgery with implants. Risk factors of organ/space SSI were studied in a prospective cohort including 3,908 patients from June 2003 to December 2006. Smoking was found as a significant risk factor for organ/space SSI. We also observed a significant difference between smokers and non-smokers for surgical wound complications (hematoma, discharge or wound dehiscence) during the period between surgical procedure and discharge from hospital. This is the first large prospective report of a significant association between smoking and organ/space SSI in orthopaedic surgery with implants.