DALLAS — Serum cotinine testing may significantly improve self-reported smoking quit rates among patients prior to total joint arthroplasty, according to study results presented at the American Association of Hip and Knee Surgeons Annual Meeting.
Further, investigators of this study noted cotinine testing helped them identify the 15% of patients who falsely report smoking abstinence, which was associated with appropriate counseling of patients concerning any inherent risks for surgery.
The study, which was conducted by Adam Hart, MD, and colleagues, was done to determine whether the self-reported quit rate among smokers may be improved upon prior to TJA through use of cotinine testing. The investigators’ institution documents, through its TJA registry, patients’ smoking status in 6-month intervals at each clinic visit and the time of surgery.
“Cotinine testing almost doubled odds of abstinence,” Hart said.
Cotinine, a metabolite of nicotine, “has a much longer half-life, ten times longer than nicotine itself. It is found in high concentrations in blood and urine and saliva, and therefore makes it a good candidate molecule for quantitative assessment,” he said.
Smoking status data were collected for patients who underwent 28,758 primary TJA surgeries to determine patients who were self-reported smokers within 1 year of unilateral TJA surgery between 2007 and 2018. Investigators separated from this cohort patients who underwent cotinine serum testing within 1 month before surgery and compared them with the smokers who did not undergo cotinine testing.
Among all patients studied, 2,514 were smokers.
“Among this cohort, there is a small group, 103 patients, with high cotinine testing within 30 days of their surgery. And, if we compare this subgroup to the entire cohort, they are similar in their age, sex, BMI and type of surgery,” Hart said.
Study results showed the abstinence rate, calculated by self-reported smoking status, before surgery significantly improved from 15.8% to 28.2% in the untested vs. cotinine-tested patients, respectively. – by Susan M. Rapp
Hart A, et al. Paper 45. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 1-4, 2018; Dallas.
Disclosure: Hart reports no relevant financial disclosures.