SUMMARY OF CONCLUSIONS OF EXPERTS
PREVENTION IN THE CONTEXT OF SMOKING
PERI - OPERATIVE
Corespondent
DR. CHRISTOPHE BURES
Member of The Frenh Society and orthopedic Surgery SOFCOT
Clinique Internationale du Parc Monceau
75017 Paris
Phone : 01 48 88 25 62
Mister ALAIN MASQUELET
Service Orthopedic Surgery and Trauma,
Hopital Avicenne, AP-HP, Paris XIII
Reference: Information gathered from
The French Society of Orthopedic Surgery
And traumatological S.O.F.C.O.T.
For fifteen years, a growing number of studies, carried out
rigorously, shows smoking as a factor in massive surgical complications in all specialties.
These complications are related to the toxic substances contained in tobacco smoke: When the smoke is inhaled, carbon monoxide reduces the blood's ability to carry oxygen.
Hypoxia has a detrimental effect on wound healing and skin tissue distribution, particularly in regard to the bone.
In addition, nicotine induced vasocontriction which restricts blood flow to peripheral tissues.
The alternatives contained in tobacco smoke have other adverse effects such as damage to endothelial cells, blocking the action of cellular enzymes and increased blood viscosity.
The surgical complications of smoking include healing difficulties, infection of surgical wounds and delays of consolidation.
Summary of conclusions
QS1 - WHAT ARE THE RISKS ASSOCIATED WITH TOBACCO DURING AN OPERATION ?
Each year, eight million patients undergo anesthesia in France and nearly two Milions interventions involving smoking.
It is established that the peri-operative smoking in adults increases the risk of general complications (tripling of risk of infection and coronary doubling of risk transfer in resuscitation and immediate respiratory complications).
Increased risk of surgical complications (2 to 4 times more complications, scarring, risk of eviscerated after laparotomy of mediastinitis, the dropping of digestive sutures, thrombosis of vascular prostheses, delayed bone consolidation).
Similarly in children, there is a relationship between the intensity of passive smoking and the incidence of respiratory complications in ENT surgery.
Smokers weaned long had a lower operative risk than non-smokers and different from that of non smokers.
• A smoking cessation 6-8 weeks before surgery leads to the disappearance of the risk of surgical complications due to smoking.
• A stop a little later 3-4 weeks before surgery brings all the operating profit.
• A stop less than 3 weeks before surgery is beneficial for the overall decrease of complications documented in the surgical site and cardiovascular risk relative controversial transient increase of respiratory complications during a stop one to 2 weeks before intervention.
WHY SMOKING AND RISK IN SURGERY AND TRAUMA ?
Several authors have shown that smoking is the risk factor most important in the complications of surgical approaches to surgical hip and knee.
Trauma, the time of consolidation of fractures of the leg is extended by one month on average among smokers.
In the planned tibial osteotomies such as corrective axis, smokers had a risk eight times more important to achieve a pseudoarthrosis.
Fusion surgery is planned particularly concerned:
the rate of non-consolidation of spinal arthrodesis is 27% among smokers against 14% among non-smokers.
The relative risk of lack of fusion in ankle arthrodesis is four times greater for smokers ...
In contrast, patients who quit smoking for a period of six months after surgery had a rate of consolidation similar to that of non smokers.
The results of various studies strongly suggest that post-operative cessation of smoking reverses the negative effects of smoking on
bone fusion, the important concept to remember is that the effects of smoking are reversible.
In practice, it is recommended to quit two months before scheduled surgery to avoid respiratory and cardiac risk, and six months after surgery to reduce the risk of not bone.
These data impose on smoking in the near future, a specific duty to inform patients of all physicians involved (general practitioner, surgeon, anesthetist), to propose a et l'obligation weaning, particularly in the case of a scheduled surgery.
