Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty

Background Smoking and alcohol use impair post-operative outcomes. However, no studies include fast-track surgery, which is a multimodal-enhanced recovery programme demonstrated to improve outcome. We hypothesised that outcome is similar in smokers and alcohol users as in non-users after fast-track hip and knee arthroplasty. Methods Prospective questionnaires on co-morbidity and smoking/alcohol use were cross-referenced with the Danish National Health Registry to investigate relationship between smoking/alcohol use and length of stay of >4 days and readmissions 90 days after fast-track hip and knee arthroplasty. Results In 3041 consecutive patients, 458 reported smoking and 216 drinking >2 drinks a day, of which 66 did both. Smokers/alcohol users were younger than non-users (mean age: 64.3 vs. 68.0 years, P<0.001). Multiple regression analysis showed no relation between length of stay of >4 days and smoking (odds ratio [95% confidence interval], P) (1.34 [0.921.95], 0.127) or alcohol use (0.59 [0.301.16], 0.127). Thirty- and ninety-day readmission rate was 6.6% (n=201) and 9.4% (n=285). Multiple logistic regression analysis showed an increased risk of readmissions in smokers at 30 (1.60 [1.052.44], 0.028) but not 90-day follow-up (1.17 [0.801.73], 0.419). No increased risk of readmissions was found in alcohol users at 30 (0.94 [0.501.76], 0.838) or 90-day follow-up (0.83 [0.471.49], 0.532). No increased risk of specific readmissions (i.e. wound infections or pneumonia) typically related to smoking/alcohol use was found in smokers (1.56 [0.932.62], 0.091) or alcohol users (1.00 [0.472.15], 0.999) at 90-day follow-up. Conclusion Influence of smoking or alcohol use may be less pronounced in fast-track hip and knee arthroplasty compared with data with conventional care programmes.