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Smokers should be denied joint replacement surgery, breast reconstruction and a wide range of other elective surgery, say doctors.
Nicotine and other chemicals in cigarette smoke slow down circulation and wound healing, and leave smokers more susceptible to post-operative infection and breathing difficulties, thoracic expert Dr Matthew Peters said in the Medical Journal of Australia.
"The risk of adverse outcomes from wound infections alone is clear enough evidence to suggest that aesthetic plastic surgery should not be offered to current smokers."
Medical ethicist Dr Nicholas Tonti-Filippini said to deny smokers surgery would be to violate human rights.
©Copyright 2004, New Zealand Herald
Ann Surg. 2003 Jul;238(1):1-5.
Abstinence from smoking reduces incisional wound infection: a randomized controlled trial.Sorensen LT, Karlsmark T, Gottrup F.*Copenhagen Wound Healing Center and the dagger Department of Surgical Gastroenterology, Bispebjerg University Hospital, Copenhagen Hospital Corporation, Denmark.OBJECTIVE Clinical studies show that the incidence of postoperative wound complications is higher in smokers than nonsmokers. In this study, we evaluated the effect of abstinence from smoking on incisional wound infection.METHODS Seventy-eight healthy subjects (48 smokers and 30 never-smokers) were included in the study and followed for 15 weeks. In the first week of the study, the smokers smoked 20 cigarettes per day. Subsequently, they were randomized to continuous smoking, abstinence with transdermal nicotine patch (25 mg per day), or abstinence with placebo patch. At the end of the first week and 4, 8, and 12 weeks after randomization, incisional wounds were made lateral to the sacrum to excise punch biopsy wounds. At the same time identical wounds were made in 6 never-smokers. In 24 never-smokers a wound was made once. All wounds were followed for 2 weeks for development of wound complications.RESULTS A total of 228 wounds were evaluated. In smokers the wound infection rate was 12% (11 of 93 wounds) compared with 2% (1 of 48 wounds) in never-smokers (P <0.05). Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4, 8, and 12 weeks after randomization. No difference between transdermal nicotine patch and placebo was found.CONCLUSIONS Smokers have a higher wound infection rate than never-smokers and 4 weeks of abstinence from smoking reduces the incidence of wound infections.PMID: 12832959
Instr Course Lect. 2004;53:325-40.
Lumbar arthrodesis for degenerative conditions.
Glaser JA, Bernhardt M, Found EM, McDowell GS, Wetzel FT.
Medical University of South Carolina, Charleston, South Carolina, USA.
There is significant disagreement among spine surgeons regarding the optimal technique of arthrodesis for treatment of degenerative disorders of the lumbar spine. Degenerative conditions of the lumbar spine include degenerative disk "disease," post-decompression degeneration, degenerative spondylolisthesis, junctional degeneration, spondylolis, and low-grade lytic spondylolisthesis. Although it is impossible to develop strict evidence-based criteria for the selection of one surgical approach over another, some generalizations are possible based on empiric process, anecdotal experience, and published surgical series. Patient selection, cessation of nicotine use, and use of autologous bone graft are factors that influence clinical outcome after lumbar arthrodesis.
PMID: 15116625 [PubMed - in process]
Guardsman's surgery postponedAugust 4, 2006 - The Meridian StarBy Georgia E. Frye / staff writer
A surgery scheduled for Thursday for Sgt. 1st Class Grayson "Norris" Galatas was postponed until Aug. 24 when lab results showed nicotine in his system.
Galatas is currently at Walter Reed Army Medical Center in Washington, D.C.
Galatas has faced several surgeries since he was wounded when an Improvised Explosive Device exploded near his vehicle April 19, 2005, while he was on duty in Iraq with the 150th Combat Engineer Battalion.
Galatas suffered severe lacerations to his stomach and back and had shrapnel wounds over much of his body. The surgery Galatas was scheduled to undergo Thursday included removing a skin graft that covers a large section of his stomach and then reconnecting his stomach to his intestines.
Galatas' wife, Janis, said the doctors at Walter Reed said nicotine constricts the blood vessels and restricts blood flow to tissue, and getting Galatas off nicotine for three weeks will enhance his chance of healing.
Norris Galatas doesn't smoke, his wife said, but never thought about mentioning smokeless tobacco when he was filling out medical paperwork.
"Norris is understandably upset because he has been waiting since July 2005 to get this done," Janis Galatas said. "However, he has healed nicely with all the other surgeries and this will only make it better. He will get over it, he always does."
Janis Galatas will return home to care for the couple's horses and return to Walter Reed in time for the surgery.
"This time I'll wait until we get the final OK before I travel," she said, "But we had some fun together for a couple of weeks."
Story source: http://www.meridianstar.com/local/local ... 11209.html
© 2006, The Meridian Star
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|Sent: 2/9/2001 8:07 AM|
But what neck disc fusion surgery where entry and disc fixation was accomplished was from the rear (posterior) instead of cutting into the front of the neck (anterior)? The below new study found that although successful fusion rates were similar between smokers and non-smokers that "Smokers were nearly five times more likely to have a fair or poor outcome compared with nonsmokers."Nicotine's Role in"The role of smoking in causing pseudarthrosis has been well studied in lumbar spine fusions with up to a fourfold increase in nonunion rates from 8% to 40% for lumbar fusions. Nicotine has a direct inhibitory effect on autologous cancellous bone graft revascularization as well as an increased rate of bone graft necrosis in a rabbit model of bone graft implantation. Systemic nicotine has also been linked to nonunion in spinal fusion animal models."
Failed Low Back Surgery
Smokers are likely to experience an Odom Criteria Grade of III or IV? What does that mean? This definition was provided in the full text of the study:Clin Orthop Relat Res. 2010 Sep 22. [Epub ahead of print]
Eubanks JD, Thorpe SW, Cheruvu VK, Braly BA, Kang JD.
BACKGROUND: Smoking is associated with reduced fusion rates after anterior cervical decompression and arthrodesis procedures. Posterior cervical arthrodesis procedures are believed to have a higher fusion rate than anterior procedures.
QUESTIONS/PURPOSES: We asked whether smoking (1) would reduce the fusion rate in posterior cervical procedures; and (2) be associated with increased pain, decreased activity level, and a decreased rate of return of work as compared with nonsmokers.
METHODS: We retrospectively reviewed 158 patients who had a posterior cervical fusion with lateral mass instrumentation and iliac crest bone grafting between 2003 and 2008. Fusion rates and Odom Criteria grades were compared among smokers and nonsmokers. The minimum followup was 3 months (average, 14.5 months; range, 3-72 months).
RESULTS: Smokers and nonsmokers had similar fusion rates (100%). Although 80% of patients had Odom Criteria Grade I or II, smokers were five times more likely to have Grade III or IV with considerable limitation of physical activity. Age, gender, and diagnosis did not influence fusion rates or the Odom Criteria grade.
CONCLUSIONS: In contrast to the effect of smoking on anterior cervical fusion, we found smoking did not decrease posterior cervical fusion with lateral mass instrumentation and iliac crest bone grafting. Posterior cervical fusion with lateral mass instrumentation should be considered over anterior procedures in smokers if the abnormality can appropriately be addressed from a posterior approach.
"The Odom Criteria have been used for decades to grade clinical outcomes after cervical spine surgery. It takes into account the patient’s daily symptoms, activity level, and ability to return to work and grades them on a scale of I to IV: Grade I (excellent) = no cervical spine symptoms, daily activities not impaired; Grade II (good) = intermittent discomfort, no substantial interference with work activities; Grade III (fair) = subjective improvement but major limitations of physical activities; and Grade IV (poor) = no improvement or worse compared with the preoperative condition."