{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:00:08Z","timestamp":1787068808643,"version":"build-2736575974"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Smoking is a potentially modifiable risk factor for adverse outcomes after total hip arthroplasty (THA), but evidence on early postoperative complications in Asian populations remains limited. This study examined the association between smoking and early postoperative complications after elective THA using a nationwide inpatient database in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study analysed data from the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Patients undergoing elective primary THA for osteoarthritis, osteonecrosis of the femoral head, or rheumatoid arthritis were included. Smoking status was identified using administrative codes. One-to-one propensity score matching was used to balance baseline characteristics between smokers and non-smokers. Primary outcomes were early postoperative surgical complications, medical complications, and in-hospital mortality. Dose-dependent effects were assessed using the Brinkman Index, with heavy smoking defined as\u2009\u2265\u2009600.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After propensity score matching, 52,551 patients were included in each group. Smoking was associated with a higher risk of postoperative infection (odds ratio [OR] 1.31; 95% confidence interval [CI] 1.15\u20131.49;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and a lower likelihood of blood transfusion (OR 0.83; 95% CI 0.80\u20130.85;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant associations were observed with dislocation, periprosthetic fracture, wound dehiscence, reoperation, major medical complications, or in-hospital mortality. Heavy smoking (Brinkman Index\u2009\u2265\u2009600) was not associated with postoperative complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Smoking was associated with an increased risk of early postoperative infection following elective THA, but not with other major complications or in-hospital mortality. Smoking cessation should be considered an important component of perioperative optimisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06747-w","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T03:58:55Z","timestamp":1770782335000},"page":"583-591","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Smoking increases the risk of early postoperative infection after elective total hip arthroplasty: Evidence from a Nationwide Japanese database"],"prefix":"10.1007","volume":"50","author":[{"given":"Hidetatsu","family":"Tanaka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunio","family":"Tarasawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Fukuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyohide","family":"Fushimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimi","family":"Aizawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Fujimori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"issue":"9597","key":"6747_CR1","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/S0140-6736(07)60457-7","volume":"370","author":"ID Learmonth","year":"2007","unstructured":"Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370(9597):1508\u20131519","journal-title":"Lancet"},{"issue":"2","key":"6747_CR2","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s11999-015-4341-7","volume":"474","author":"WL Healy","year":"2016","unstructured":"Healy WL, Iorio R, Clair AJ, Pellegrini VD Jr, Della Valle CJ, Berend KR (2016) Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the Hip Society. Clin Orthop Relat Res 474(2):357\u2013364","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"6747_CR3","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1016\/j.arth.2016.11.055","volume":"32","author":"PM Courtney","year":"2017","unstructured":"Courtney PM, Boniello AJ, Berger RA (2017) Complications following outpatient total joint arthroplasty: an analysis of a national database. J Arthroplasty 32(5):1426\u20131430","journal-title":"J Arthroplasty"},{"issue":"8","key":"6747_CR4","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1016\/j.arth.2019.03.059","volume":"34","author":"EM Debbi","year":"2019","unstructured":"Debbi EM, Rajaee SS, Spitzer AI, Paiement GD (2019) Smoking and total hip arthroplasty: increased inpatient complications, costs, and length of stay. J Arthroplasty 34(8):1736\u20131739","journal-title":"J Arthroplasty"},{"issue":"1","key":"6747_CR5","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-02829-8","volume":"15","author":"H Tanaka","year":"2025","unstructured":"Tanaka H, Tarasawa K, Mori Y, Baba K, Fukuchi H, Fushimi K et al (2025) High risk of postoperative complications in dialysis patients undergoing total hip arthroplasty: a database study of Japanese nationwide medical claims. Sci Rep 15(1):24211","journal-title":"Sci Rep"},{"issue":"9301","key":"6747_CR6","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/S0140-6736(02)07369-5","volume":"359","author":"AM M\u00f8ller","year":"2002","unstructured":"M\u00f8ller AM, Villebro N, Pedersen T, T\u00f8nnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 359(9301):114\u2013117","journal-title":"Lancet"},{"issue":"10","key":"6747_CR7","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1302\/0301-620X.88B10.17957","volume":"88","author":"O Sadr Azodi","year":"2006","unstructured":"Sadr Azodi O, Bellocco R, Eriksson K, Adami J (2006) The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br 88(10):1316\u20131320","journal-title":"J Bone Joint Surg Br"},{"issue":"1","key":"6747_CR8","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1177\/112070000901900109","volume":"19","author":"LA Khan","year":"2009","unstructured":"Khan LA, Cowie JG, Ballantyne JA, Brenkel IJ (2009) The complication rate and medium-term functional outcome after total hip replacement in smokers. Hip Int 19(1):47\u201351","journal-title":"Hip Int"},{"issue":"6","key":"6747_CR9","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1097\/SLA.0b013e31824f632d","volume":"255","author":"LT S\u00f8rensen","year":"2012","unstructured":"S\u00f8rensen LT (2012) Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 255(6):1069\u20131079","journal-title":"Ann Surg"},{"issue":"4","key":"6747_CR10","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.arth.2013.08.023","volume":"29","author":"BH Kapadia","year":"2014","unstructured":"Kapadia BH, Issa K, Pivec R, Bonutti PM, Mont MA (2014) Tobacco use may be associated with increased revision and complication rates following total hip arthroplasty. J Arthroplasty 29(4):777\u2013780","journal-title":"J Arthroplasty"},{"issue":"6","key":"6747_CR11","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1002\/jor.22603","volume":"32","author":"A L\u00fcbbeke","year":"2014","unstructured":"L\u00fcbbeke A, Rothman KJ, Garavaglia G, Barea C, Christofilopoulos P, Stern R et al (2014) Strong association between smoking and the risk of revision in a cohort study of patients with metal-on-metal total hip arthroplasty. J Orthop Res 32(6):762\u2013768","journal-title":"J Orthop Res"},{"issue":"4","key":"6747_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125294","volume":"10","author":"S Teng","year":"2015","unstructured":"Teng S, Yi C, Krettek C, Jagodzinski M (2015) Smoking and risk of prosthesis-related complications after total hip arthroplasty: a meta-analysis of cohort studies. PLoS One 10(4):e0125294","journal-title":"PLoS One"},{"issue":"4","key":"6747_CR13","doi-asserted-by":"publisher","first-page":"295","DOI":"10.2106\/JBJS.16.00311","volume":"99","author":"EH Tischler","year":"2017","unstructured":"Tischler EH, Matsen Ko L, Chen AF, Maltenfort MG, Schroeder J, Austin MS (2017) Smoking increases the rate of reoperation for infection within 90 days after primary total joint arthroplasty. J Bone Joint Surg Am 99(4):295\u2013304","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"6747_CR14","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/j.arth.2018.09.089","volume":"34","author":"NA Bedard","year":"2019","unstructured":"Bedard NA, DeMik DE, Owens JM, Glass NA, DeBerg J, Callaghan JJ (2019) Tobacco use and risk of wound complications and periprosthetic joint infection: a systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty 34(2):385-396.e4","journal-title":"J Arthroplasty"},{"issue":"4","key":"6747_CR15","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1016\/j.artd.2020.07.011","volume":"6","author":"B Bojan","year":"2020","unstructured":"Bojan B, Perni S, Prokopovich P (2020) Systematic review and meta-analysis of tobacco use as a risk factor for prosthetic joint infection after total hip replacement. Arthroplast Today 6(4):959\u2013971","journal-title":"Arthroplast Today"},{"issue":"5","key":"6747_CR16","doi-asserted-by":"publisher","first-page":"e639","DOI":"10.3928\/01477447-20210817-03","volume":"44","author":"ND Heckmann","year":"2021","unstructured":"Heckmann ND, Katebian B, Chung BCH, Lieberman JR (2021) Smoking as a risk factor for complications following total joint arthroplasty. Orthopedics 44(5):e639\u2013e644","journal-title":"Orthopedics"},{"key":"6747_CR17","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.artd.2021.05.021","volume":"10","author":"JM Statz","year":"2021","unstructured":"Statz JM, Odum SM, Johnson NR, Otero JE (2021) Failure to medically optimize before total hip arthroplasty: which modifiable risk factor is the most dangerous? Arthroplast Today 10:18\u201323","journal-title":"Arthroplast Today"},{"key":"6747_CR18","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.970537","volume":"9","author":"C Yue","year":"2022","unstructured":"Yue C, Cui G, Ma M, Tang Y, Li H, Liu Y et al (2022) Associations between smoking and clinical outcomes after total hip and knee arthroplasty: a systematic review and meta-analysis. Front Surg 9:970537","journal-title":"Front Surg"},{"key":"6747_CR19","doi-asserted-by":"publisher","first-page":"114","DOI":"10.2340\/17453674.2024.39966","volume":"95","author":"J Bongers","year":"2024","unstructured":"Bongers J, Belt M, Spekenbrink-Spooren A, Smulders K, Schreurs BW, Koeter S (2024) Smoking is associated with higher short-term risk of revision and mortality following primary hip or knee arthroplasty: a cohort study of 272,640 patients from the Dutch Arthroplasty Registry. Acta Orthop 95:114\u2013120","journal-title":"Acta Orthop"},{"issue":"4","key":"6747_CR20","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1177\/11207000241230272","volume":"34","author":"MJ Hadad","year":"2024","unstructured":"Hadad MJ, Grits D, Emara AK, Orr MN, Murray TG, Piuzzi NS (2024) Trends in prevalence and complications for smokers who underwent total hip arthroplasty from 2011 to 2019: an analysis of 243,163 patients. Hip Int 34(4):432\u2013441","journal-title":"Hip Int"},{"issue":"1","key":"6747_CR21","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14375","volume":"21","author":"J Zhu","year":"2024","unstructured":"Zhu J, Si M, Huang Z (2024) Effect of tobacco usage on surgical site wound problems after primary total hip and total knee arthroplasty: a meta-analysis. Int Wound J 21(1):e14375","journal-title":"Int Wound J"},{"issue":"12","key":"6747_CR22","doi-asserted-by":"publisher","DOI":"10.2196\/42619","volume":"24","author":"K Taira","year":"2022","unstructured":"Taira K, Itaya T, Fujita S (2022) Predicting smoking prevalence in Japan using search volumes in an internet search engine: infodemiology study. J Med Internet Res 24(12):e42619","journal-title":"J Med Internet Res"},{"issue":"4","key":"6747_CR23","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1089\/ten.teb.2014.0090","volume":"20","author":"T Aoyama","year":"2014","unstructured":"Aoyama T, Goto K, Kakinoki R, Ikeguchi R, Ueda M, Kasai Y et al (2014) An exploratory clinical trial for idiopathic osteonecrosis of the femoral head by cultured autologous multipotent mesenchymal stromal cells augmented with vascularized bone grafts. Tissue Eng Part B Rev 20(4):233\u2013242","journal-title":"Tissue Eng Part B Rev"},{"key":"6747_CR24","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.reth.2022.03.002","volume":"20","author":"Y Homma","year":"2022","unstructured":"Homma Y, Masubuchi Y, Shirogane Y, Amano H, Muramoto Y, Nagao M et al (2022) Grafting of autologous concentrated bone marrow processed using a point-of-care device for patients with osteonecrosis of the femoral head: a phase 1 feasibility and safety study. Regen Ther 20:18\u201325","journal-title":"Regen Ther"},{"issue":"1","key":"6747_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/s43019-025-00273-6","volume":"37","author":"Y Mori","year":"2025","unstructured":"Mori Y, Tarasawa K, Tanaka H, Kamimura M, Harada K, Mori N et al (2025) Thromboembolic and infectious complication risks in TKA and UKA: evidence from a Japanese nationwide cohort. Knee Surgery & Related Research 37(1):19","journal-title":"Knee Surgery & Related Research"},{"issue":"2","key":"6747_CR26","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s00774-024-01564-w","volume":"43","author":"Y Mori","year":"2025","unstructured":"Mori Y, Tarasawa K, Tanaka H, Mori N, Fushimi K, Aizawa T et al (2025) Nationwide database study of postoperative sequelae and in-hospital mortality in super-elderly hip fracture patients. J Bone Miner Metab 43(2):141\u2013148","journal-title":"J Bone Miner Metab"},{"key":"6747_CR27","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1007\/s00402-025-06116-z","volume":"145","author":"H Tanaka","year":"2025","unstructured":"Tanaka H, Tarasawa K, Mori Y, Kurishima H, Kawamata H, Fushimi K et al (2025) Computer-assisted total hip arthroplasty reduces early complications based on Japanese nationwide medical claims data. Arch Orthop Trauma Surg 145:499","journal-title":"Arch Orthop Trauma Surg"},{"issue":"8","key":"6747_CR28","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1016\/j.arth.2025.01.029","volume":"40","author":"H Tanaka","year":"2025","unstructured":"Tanaka H, Tarasawa K, Mori Y, Kuriyama Y, Kawamata H, Fushimi K et al (2025) Does osteonecrosis of the femoral head increase early complication rates after total hip arthroplasty? A Japanese nationwide medical claims database study. J Arthroplasty 40(8):2053\u20132059","journal-title":"J Arthroplasty"},{"issue":"3","key":"6747_CR29","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1002\/art.1790080309","volume":"8","author":"JM Grosflam","year":"1995","unstructured":"Grosflam JM, Wright EA, Cleary PD, Katz JN (1995) Predictors of blood loss during total hip replacement surgery. Arthritis Care Res 8(3):167\u2013173","journal-title":"Arthritis Care Res"},{"issue":"3","key":"6747_CR30","first-page":"353","volume":"22","author":"Y He","year":"2022","unstructured":"He Y, Omar M, Feng X, Neunaber C, Jagodzinski M (2022) Impact of smoking on the incidence and post-operative complications of total knee arthroplasty: a systematic review and meta-analysis of cohort studies. Bosn J Basic Med Sci 22(3):353\u2013365","journal-title":"Bosn J Basic Med Sci"},{"key":"6747_CR31","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8030406","author":"S Ehnert","year":"2019","unstructured":"Ehnert S, Aspera-Werz RH, Ihle C, Trost M, Zirn B, Flesch I et al (2019) Smoking dependent alterations in bone formation and inflammation represent major risk factors for complications following total joint arthroplasty. J Clin Med. https:\/\/doi.org\/10.3390\/jcm8030406","journal-title":"J Clin Med"},{"issue":"9","key":"6747_CR32","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.3899\/jrheum.101221","volume":"38","author":"JA Singh","year":"2011","unstructured":"Singh JA (2011) Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol 38(9):1824\u20131834","journal-title":"J Rheumatol"},{"issue":"2","key":"6747_CR33","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.amjmed.2010.09.013","volume":"124","author":"E Mills","year":"2011","unstructured":"Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO (2011) Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med 124(2):144-154.e8","journal-title":"Am J Med"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-026-06747-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-026-06747-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-026-06747-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T16:13:32Z","timestamp":1773764012000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-026-06747-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["6747"],"URL":"https:\/\/doi.org\/10.1007\/s00264-026-06747-w","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"value":"0341-2695","type":"print"},{"value":"1432-5195","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]},"assertion":[{"value":"18 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}