The effect of cigarette smoking on hindfoot fusions

In a group of 160 patients who had hindfoot fusions (isolated subtalar, talonavicular, and calcaneocuboid fusions and double and triple arthrodeses), smokers had a significantly higher rate of nonunion than did nonsmokers (18.6% vs. 7.1%). The relative risk of developing a nonunion was 2.7 times higher for smokers than nonsmokers. With the numbers available, there was a trend for patients who had quit smoking prior to surgery to have a higher rate of nonunion (11.1%) than patients who had never smoked, but not as high as those who continued to smoke. There was no statistical difference in the rate of infection or delayed wound healing among the groups.