Does timing matter? The effect of preoperative smoking cessation on the risk of infection or revision following rotator cuff repair.

Background: Nicotine in tobacco products is known to impair bone and tendon healing, and smoking has been associated with an increased rate of retear and reoperation following rotator cuff repair (RCR). Although smoking is known to increase the risk of failure following RCR, former smoking status and the timing of preoperative smoking cessation have not previously been investigated.

Methods: A national all-payer database was queried for patients undergoing RCR between 2010 and 2020. Patients were stratified into 5 mutually exclusive groups according to smoking history: (1) never smokers (n = 50,000), (2) current smokers (n = 28,291), (3) former smokers with smoking cessation 3-6 months preoperatively (n = 34,513), (4) former smokers with smoking cessation 6-12 months preoperatively (n = 786), and (5) former smokers with smoking cessation >12 months preoperatively (n = 1399). The risks of postoperative infection and revision surgery were assessed at 90 days, 1 year, and 2 years following surgery. Multivariate logistic regressions were used to isolate and evaluate risk factors for postoperative complications.

Results: The 90-day rate of infection following RCR was 0.28% in never smokers compared with 0.51% in current smokers and 0.52% in former smokers who quit smoking 3-6 months prior to surgery (P < .001). Multivariate logistic regression identified smoking (odds ratio [OR], 1.49; P < .001) and smoking cessation 3-6 months prior to surgery (OR, 1.56; P < .001) as risk factors for 90-day infection. The elevated risk in these groups persisted at 1 and 2 years postoperatively. However, smoking cessation >6 months prior to surgery was not associated with a significant elevation in infection risk. In addition, smoking was associated with an elevated 90-day revision risk (OR, 1.22; P = .038), as was smoking cessation between 3 and 6 months prior to surgery (OR, 1.19; P = .048). The elevated risk in these groups persisted at 1 and 2 years postoperatively. Smoking cessation >6 months prior to surgery was not associated with a statistically significant elevation in revision risk.

Conclusion: Current smokers and former smokers who quit smoking within 6 months of RCR are at an elevated risk of postoperative infection and revision surgery at 90 days, 1 year, and 2 years postoperatively compared with never smokers. Former smokers who quit >6 months prior to RCR are not at a detectably elevated risk of infection or revision surgery compared with those who have never smoked.