Smoking cessation prior to total shoulder arthroplasty: A systematic review of outcomes and complications

Background: We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery. Methods: A literature search was performed using the search terms “shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine].” Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges. Results: Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly (p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications. Discussion: Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended. Level of Evidence: Level III, Systematic Review.