Smoking is associated with surgical site infection, unplanned reoperation, and unplanned 30-day readmission with distal upper extremity fractures

Background: The purpose of this study is to 1) determine the effect of smoking status on the rate of acute postoperative complications and 2) evaluate smoking as an independent risk factor for complications following open reduction and internal fixation (ORIF) of distal upper extremity fractures. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify adult patients (>18 yr old) who underwent open reduction and internal fixation (ORIF) of distal upper extremity fractures between 2005 and 2018. Closed fractures of the distal radius, distal ulna, carpals, metacarpals, and phalanx were included. Open fractures, closed reduction and percutaneous pinning (CRPP) procedures, and operations with concomitant procedure codes were excluded. Patients were classified as either current smokers or non-smokers. Univariate analysis and multivariate logistic regression were used to assess the risk of perioperative complications based on current smoking status. Results: A total of 22,002 patients met inclusion criteria. Smoking was independently associated with an increased risk of post-operative complications (OR 1.43, 1.15-1.78, P<0.001), specifically, superficial surgical site infections (OR 2.11, CI 1.23–3.60, P=0.007). Current smokers were additionally associated with an increased risk of unplanned reoperation (OR 1.65, CI 1.10–2.48, P=0.022), and unplanned readmission (OR 1.39, CI 1.02-1.90, P=0.037). Conclusions: Smoking independently increases the risk for overall complications including superficial infections, unplanned reoperation, and unplanned readmission following ORIF of distal upper extremity fractures. Level of Evidence: III.