Cotinine Testing Improves Smoking Cessation Before Total Joint Arthroplasty
| Autor: | Tad M. Mabry, William G. Rainer, Michael J. Taunton, Adam Hart, Matthew P. Abdel, Daniel J. Berry |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Risk medicine.medical_specialty Joint arthroplasty media_common.quotation_subject medicine.medical_treatment Arthroplasty Nicotine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine medicine Humans Orthopedics and Sports Medicine Cotinine Aged Retrospective Studies media_common 030222 orthopedics business.industry Smoking Tobacco Use Disorder Perioperative Middle Aged Abstinence chemistry Cohort Smoking cessation Female Smoking Cessation business Body mass index medicine.drug |
| Zdroj: | The Journal of Arthroplasty. 34:S148-S151 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2018.11.039 |
| Popis: | Background Patients who are actively smoking at the time of primary total joint arthroplasty (TJA) are at an increased risk of perioperative complications. Serum cotinine testing is a sensitive and specific method to verify abstinence from smoking and may therefore improve a patient’s chance of smoking cessation. The primary purpose of this study was to assess whether cotinine testing improves the self-reported quit rate among smokers before TJA. Methods Our hospital performs a high volume of TJAs and documents smoking status at each clinic visit (at 6-month intervals), as well as at the time of surgery through an institutional total joint registry. As part of a retrospective analysis, this information was used to identify all self-reported smokers (regularly cigarette smoking within 1 year of TJA) who underwent unilateral TJA from 2007 to 2018. The cohort had a mean age of 66 years, 55% were female, and the mean body mass index was 31 kg/m2. Patients whose serum cotinine was obtained within 1 month before surgery were then separated from the cohort and compared to the smokers who did not undergo cotinine testing. Results Of the 28,758 primary TJAs identified, 8.8% (2514) were smokers. Serum cotinine testing was obtained on 103 of these patients. The abstinence rate (by means of self-reporting) before surgery significantly improved from 15.8% to 28.2% in the untested vs cotinine-tested groups, respectively (P = .005). Among all patients who underwent cotinine testing, 77% were negative (abstinent) and an additional 15% had cotinine levels between 3 and 8 ng/mL representing passive tobacco exposure. Among patients who stated they had quit smoking, 15% still had positive cotinine tests. Conclusion Smoking cessation remains a major challenge in contemporary TJA practices despite a concerted effort to help patients quit. Our findings suggest that cotinine testing significantly improves the self-reported quit rates of smokers before surgery and helps identify the 15% who falsely report abstinence to ensure appropriate counseling of inherent risks. Level of Evidence Therapeutic level III. |
| Databáze: | OpenAIRE |
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