The effect of smoking on clinical outcome and complication rates following Ilizarov reconstruction

Objective: To determine the effect of smoking on outcome and complication rates following Ilizarov reconstruction. Design: We performed a retrospective review of 84 adult patients (86 limbs) who underwent Ilizarov reconstruction. There were 39 "limbs" in nonsmokers and 47 "limbs" in active smokers. Complications and an outcome score based on ASAMI (Association for the Study and Application of the Methods of Ilizarov) criteria were recorded for each patient. Data Analysis and Results: There were 35 major complications including 15 malunions/nonunions, 7 refractures, 8 persisting infections, and 5 amputations. Results were measured using the ASAMI outcome scale. There were significantly more poor results in the smoking group than in the nonsmoking group (18/47, 38% versus 4/39, 10%; P = 0.003). Seven of eight patients with persisting infection were smokers (P = 0.049). There was a higher incidence of nonunion in the smoking group (P = 0.031). All five amputations were in smokers (P = 0.035). Conclusion: Smokers had a higher percentage of poor results (P = 0.01), due primarily to higher complication rates. Smoking is a significant, potentially remediable risk factor for failure following Ilizarov reconstruction, and cessation strategies are of paramount importance prior to initiating treatment.