Moderate evidence suggests that smoking is associated with inferior post-operative outcomes.


Literature analysis regarding smoking history and shoulder arthroplasty revealed one high quality (Bernstein et al 2017) and two low quality studies (Leschinger et al 2017, and Wells et al 2018) resulting in a moderate level of evidence supporting the detrimental effect on postoperative patient outcomes and higher complication rates. Two additional studies by Altfhoff et al 2019, and Tata et al did not satisfy the inclusion criteria for this CPG, though are relevant for discussion. Althoff et al in their analysis of the American College of Surgeons NSQIP found an increased risk of overall surgical complications specific to wound healing and surgical site infection. Tata et al concluded that both current and former smokers had significantly higher risk of periprosthetic infection in comparison with nonsmokers. Additionally, current smokers demonstrated a higher risk of postoperative fractures than both former smokers and nonsmokers.


Strength of Evidence (quality of evidence): Moderate


Benefits & Harms:

Smoking (tobacco consumption) remains a national health concern with widespread effects on patient health, not necessarily specific to outcomes and complications associated with shoulder arthroplasty for GJO. Patient counseling, behavioral modification, and medication regimens may reduce perioperative usage of tobacco products and reduce complications rates after shoulder arthroplasty.


Future Research:

Future high-quality studies are required to compare the early and late complications associated with shoulder arthroplasty in smokers versus non-smokers.


Additional References:

Althoff, A.D., Reeves, R.A., Traven, S.A., Wilson, J.M., Woolf, S.K., Slone, H.S., Smoking is associated with increased surgical complications following total shoulder arthroplasty: an analysis of 14,465 patients. J Shoulder Elbow Surg. 2019; 1-6.

Hatta, T., Werthel, J.D., Wagner, E.R., et. al. Effect of smoking on complications following primary shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(1):1-6. 


The Future of OrthoGuidelines


The OrthoGuidelines Process