The Impact of Smoking on Complications After Operatively Treated Ankle Fractures-A Follow-Up Study of 906 Patients

Objectives: This study on patients with operatively treated ankle fractures aimed to investigate the impact of smoking on postoperative complications and especially deep wound infections. Design: Cohort study with prospective follow-up. Setting: University-associated teaching hospital with advanced trauma care. Patients: A consecutive series of patients (n = 906) operatively treated for an acute ankle fracture during a 3-year period was identified. For the analysis, the patients were categorized as nonsmokers n = 721) and smokers n = 185). Data were collected from the department database and completed with a review of the patients' medical charts. Main Outcome Measures: Postoperative complications. Results: Follow-up data at 6 weeks were available for 98.2% of the patients. Postoperative complications of any kind (30.1% versus 20.3%, P = 0.005) as well as deep wound infections (4.9% versus 0.8%, P < 0.001) were more common among smokers than nonsmokers. Multivariable analyses showed that smokers had six times higher odds of developing a deep infection compared with nonsmokers. A more complicated fracture, associated diabetes mellitus, and unsatisfactory operative fracture reduction also enhanced the risk of postoperative complications. Conclusions: We conclude that cigarette smoking increases the risk of postoperative complications in patients operatively treated for an ankle fracture. Smoking is a considerable risk factor. Therefore, physicians, nurses, and other healthcare professionals should strive to support patients to stop smoking while still under acute treatment.