Smoke = Fire? Complications After Ankle or Hindfoot Fusion in Users of Smokeless Tobacco

A soft study nonetheless carries a practical, important message

What’s the Claim?

A large-database study evaluating the association of smokeless tobacco use with complications after ankle or hindfoot fusion found users of smokeless tobacco had higher odds of:

  • Wound dehiscence within 90 days of surgery (OR 3 [95% CI 1.2 to 7])
  • Infection and nonunion 2 years after surgery (OR 6 [95% CI 1.2 to 32] and 2.4 [1.3 to 4.2], respectively)

This study had a number of difficult-to-understand findings that raise the concern about unmeasured confounding. But the main discovery here — that smokeless tobacco is a likely risk factor for wound healing and infection — seems very likely to hold up under scrutiny, and, honestly, it’s not something we’d ever even considered before.

How’s It Stack Up?