Association of Cigarette Smoking With Pulmonary Embolism and Healthcare Utilization Following Hip and Knee Versus Shoulder Arthroscopy.

BACKGROUND

Cigarette smoking is a well-established risk factor for adverse surgical outcomes due to its prothrombotic, inflammatory, and cardiopulmonary effects. However, its impact on short-term complications following arthroscopic surgery remains poorly defined. The purpose of the study is to evaluate the association between cigarette smoking and 90-day postoperative complications after shoulder, hip, and knee arthroscopic procedures.

METHODS

Using a multicenter database, TriNetX, patients undergoing arthroscopic shoulder, hip, or knee procedures were retrospectively identified. Smokers were propensity score-matched 1:1 to nonsmoking controls by age, sex, comorbidities, and type of arthroscopic procedure. Ninety-day rates of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), emergency department (ED) visits, hospital readmissions, postoperative infection, and wound dehiscence were compared between smokers and nonsmokers. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Among 18,948 shoulder arthroscopy patients, smoking was not associated with increased risk of VTE (RR, 1.086; 95% CI, 0.687-1.717; p = 0.815), DVT (RR, 1.037; 95% CI, 0.612-1.758; p = 1.000), or PE (RR, 1.000; 95% CI, 0.464-2.156; p = 1.000). Smokers demonstrated higher ED utilization (RR, 1.627; 95% CI, 1.435-1.844; p < 0.001), but no significant differences in readmission, infection, or wound complications. Among 24,196 hip/knee arthroscopy patients, smoking was not associated with overall VTE risk (RR, 1.103; 95% CI, 0.839-1.450; p = 0.527) or DVT (RR, 0.989; 95% CI, 0.737-1.326; p = 1.000), but was linked to an increased risk of PE (RR, 1.938; 95% CI, 1.060-3.540; p = 0.041). Cigarette smoking was further associated with higher ED visits (RR, 1.775; p < 0.001), readmissions (RR, 2.250; p < 0.001), and postoperative infections (RR, 1.525; p = 0.046) for knee and hip arthroscopy patients.

CONCLUSION

Cigarette smoking was not associated with increased overall VTE risk after shoulder arthroscopy but was linked to higher ED utilization. In lower extremity arthroscopy, smokers demonstrated an association with increased risk of PE, healthcare utilization, and infection. These findings highlight the need for targeted perioperative counseling and risk reduction strategies in patients who smoke undergoing arthroscopy.