The Effect of Cigarette Smoking on Radiographic Bone Healing After Elective Foot Surgery

This study aims to compare radiographic healing rates of Austin bunionectomies in smokers, nonsmokers, and secondhand smokers. Delayed bone healing has been linked to cigarette smoking previously, but no study is known to have examined smoking in relation to elective foot surgery. We hypothesized that smoking will delay bone healing after elective foot surgery. Surgical patients were placed into 1 of 3 cigarette smoking-related groups. Nicotine dependence was measured by the standardized modified Fagerstrom est and a urine cotinine test. Bone healing was determined via examination of postsurgical radiographs. Outcomes were assessed with 1-way analyses of variance. Forty-six patients were prospectively evaluated. There were 17 smokers, 12 secondhand smokers, and 17 nonsmokers. Healing time after Austin bunionectomy was 69 days (SD = 26.0), 120 days (SD = 55.3), and 78 days (SD = 19.1) in nonsmokers, smokers, and secondhand smokers, respectively. It was noted that as urine cotinine number increased, the healing time also increased (Pearson correlation = -.314, P < .01). The same was noted with the score associated with the Fagerstrom questionnaire, showing an increase in healing time with an increase in score (Pearson correlation = -.128, P < .05). The osteotomy of a smoker took 1.73 times longer to reach radiographic bone consolidation than that of a nonsmoker. This equates to a 42% increase in time to bone healing in the smoking patient. Increased healing time was also correlated to increased urine cotinine and a higher Fagerstrom number. Smoking is shown to delay radiographic healing. Level of Clinical Evidence: 2 (The Journal of Foot & Ankle Surgery 48(5):525-527, 2009)