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Smoking ,Tests Ortho Surgeons Think About - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes tests that orthopaedic surgeons should think about - Nicotine / Cotinine test. Smoking/nicotine and cotinine level. A doctor should ask the patient to stop smoking before the elective surgery. Cotinine test may be ordered for evaluation of the patient's tobacco use. Cotinine levels can be detected in either the blood, the urine, or the saliva. Cotinine is found in tobacco and is the main metabolite of nicotine. It is the best biomarker for exposure to tobacco smoke. The level of cotinine in the blood is proportional to the amount of exposure to tobacco smoke, which is includes exposure to secondary smoke. Cotinine levels less than or equal to 10 ng/mL are consistent with no active smoking. Cotinine levels from 10-100 ng/mL signal light smoking. Finally, cotinine levels above 300 ng/mL signals a heavy smoker (more than 20 cigarettes per day). The urine concentration of cotinine is 4-6x more than in the blood or saliva, making the urine test more sensitive in detecting low concentration exposure. Active smokers may reach levels of 500 ng/mL in the urine. Smoking is not only harmful to the lungs and heart, but it is also harmful to the bones and soft tissues. It can also cause cancer. Smoking decreases wound healing, and may cause surgical site infection and pneumonia after THA or TKA. Smoking is a risk factor for osteoporosis. Smokers are 3x more likely to develop chronic back pain. There is a correlation between spine fusion and smoking. Smoking and other tobacco use play an important roles in inhibiting bone healing with an increased risk of nonunion of fractures, and pseudoarthrosis (non-fusion) in spine surgery. Pseudoarthrosis of the spine after spine fusion can be up to 5x more likely to occur in a smoker that in a nonsmoker. Nicotine causes vasoconstriction of the small blood vessels and decreases the blood flow to the area that is already compromised by the injury or by the surgery. In smokers, there is an increased risk of nonunion and decreased patient satisfaction after spine fusion. There is also an increased risk for recurrent herniation and re-operation following lumbar disc surgery. These risks are reduced if the patient quits smoking permanently. There is a decreased incidence of rotator cuff tears in smokers compared to nonsmokers. There is also a correlation between smoking and rotator cuff surgery- the results are better in nonsmokers. The patient will have less pain and a higher degree of function if they are a nonsmoker. Smoking in general, whether it is directly or passively, has a serious negative effect on the musculoskeletal system with increased pain in the neck and lower back, increased incidence of rotator cuff tears, and shoulder dysfunction with less than satisfactory outcome after rotator cuff surgery. Smoking is probably the single most important factor in post-operative complications. The AAOS is taking an active role in teaching and educating physicians about the risks associated of smoking. Smoking cessation before before surgery appears to benefit the patients who are undergoing surgery. The longer the cessation of smoking, the better the result. The patient can reduce their risks by stopping smoking before surgery. The physician should engage with the patient and provide them with educational material that will benefit the patient. Multidisciplinary team, biofeedback, and behavioral therapy are usually helpful. Obesity, diabetes, and smoking are very serious health hazards. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC