Influence of smoking on shoulder arthroplasty outcomes: A meta-analysis of postoperative complications

Introduction Although advancements in surgical techniques and postoperative management have improved outcomes, the impact of smoking on shoulder arthroplasty outcomes remains controversial. This study aimed to evaluate the influence of smoking on shoulder arthroplasty outcomes and provide a clearer perspective on the controversy surrounding the impact of smoking on medical and surgical complications.Methods A systematic search was conducted using four Library databases. PROSPERO (CRD42023444819). The quality of the studies was assessed using the Methodological Index for Non-randomized Studies. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated for the dichotomous and continuous variables. This study used the PICOS strategy to identify studies with patients undergoing shoulder arthroplasty surgery, with smoking as the intervention, non-smoking as the comparison, and postoperative complications as the outcome.Results The meta-analysis included eight studies with 227,329 patients. The smoking group had a higher risk of readmission (OR: 1.11, 95% CI [1.05-1.17]), revision (OR: 2.32, 95% CI [1.28-4.23]), periprosthetic fracture (OR: 1.38, 95% CI [1.24-1.53]), and surgical site infection (OR: 2.09, 95% CI [1.77-2.47]), but no significant differences were found in wound problems or thromboembolic events. The smoking group had a higher risk of sepsis (OR: 1.31, 95% CI [1.07-1.60]). There were no significant differences in renal complications, urinary tract infections, pulmonary complications, or myocardial infarctions between the two groups.Conclusion Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce the costs associated with complications and joint replacement in patients undergoing shoulder arthroplasty.Implications These findings emphasize the need to promote a tobacco-free lifestyle and improve surgical outcomes. Preoperative interventions should include education, counseling, and support, fostering better shoulder arthroplasty results and long-term well-being.