Abstract
Object: Smoking is a negative prognostic factor in the outcome of some fractures. We evaluated whether smoking is associated with primary care quality and referral to orthopedic surgeons for an isolated injury.
Materials and Methods: We enrolled all new ambulatory cases with an isolated injury to an extremity referred to an orthopedic trauma clinic. Data were analyzed concerning: type of trauma, prior medical consultations, quality of initial management, patient characteristics and smoking status.
Results: Among 166 consecutive patients referred, 45 were smokers. Family income was under $30 000 for 44% of smokers compared to 27% for non-smokers (p< 0,05). Smokers were younger (43 y.o. vs 50 y.o.; p< 0,05) and used illegal drugs more often (16% vs 5%; p< 0,05). Smokers were more likely to have been injured at work while non -smokers reported their injury as a sport accident. Injury severity, type of injury and ethnic characteristics were not different. Smokers were twice as likely to receive an unacceptable immobilization for their injury than non-smokers (52% vs 25%; p< 0,05) and received inadequate walking aids (26% vs 9%;0< 0,05). Delay from first primary care consultation to orthopedic appointment was almost 2 times longer for smokers (93hrs vs 58hrs; p< 0,05).
Discussion and Conclusion: Injured smokers received a lower standard of care and had longer delays for orthopedic consultations. Primary care quality and efficiency were associated with smoking status, possibly due to medical bias or incorrect use of health service by patients. Relevance: Smoking is a risk factor for complications in orthopedic surgery. Our results suggest that biology may not be the only explanation.
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