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Effect of Smoking Cessation Intervention on Results of Acute Fracture Surgery: A Randomized Controlled Trial

Nåsell, Hans MD; Adami, Johanna MD, PhD; Samnegård, Eva MD, PhD; Tønnesen, Hanne PhD; Ponzer, Sari MD, PhD

Journal of Bone & Joint Surgery - American Volume: June 2010 - Volume 92 - Issue 6 - p 1335–1342
doi: 10.2106/JBJS.I.00627
Scientific Articles

Background: Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking cessation program, initiated during the acute hospitalization period and carried out for six weeks, could reduce the number of complications following emergency surgical treatment of fractures.

Methods: In a multicenter, single-blinded, randomized, controlled clinical trial, 105 smokers with a fracture of the lower or upper extremity that needed acute surgical treatment were randomized to an intervention group (n = 50) or a control group (n = 55). The intervention group was offered a standardized smoking cessation program for six weeks, and all patients were followed at two to three weeks, four weeks, and six to twelve weeks.

Results: The proportion of patients with at least one postoperative complication was significantly larger in the control group than it was in the intervention group (38% and 20%, respectively; p = 0.048). The development of two or more postoperative complications was also more common among the controls (p = 0.039). The rates of superficial wound infection, the most frequently recorded complication in both groups, were 20% and 8%, but this difference was not significant. A secondary analysis showed that the odds of having a complication were 2.51 times (95% confidence interval, 0.96 to 6.9 times) higher in the control group than in the intervention group, but this difference was not significant.

Conclusions: Our results indicate that a smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

1Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, S-118 83 Stockholm, Sweden. E-mail address for H. Nåsell: E-mail address for S. Ponzer: sari.ponzer@ki.sehans

2Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Solna, S-17176 Stockholm, Sweden. E-mail address:

3Section of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, S-182 88 Stockholm, Sweden. E-mail address:

4WHO-Collaborating Centre for Evidence-Based Health Promotion, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 København NV Denmark. E-mail address:

Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated
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