{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:14:05Z","timestamp":1777612445869,"version":"3.51.4"},"reference-count":45,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The purpose of this study was to (1) evaluate the rates of postoperative complications following ankle or hindfoot arthrodesis among current smokeless tobacco users and people who smoke compared to matched controls, and (2) compare rates of postoperative complications in current smokeless tobacco users vs people who smoke tobacco cigarettes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using a large national database. For patients who underwent ankle or hindfoot arthrodesis, smokeless tobacco users (n\u2009=\u2009131) and people who smoke (n\u2009=\u20091948) were matched 1:4 with controls, and smokeless tobacco users (n\u2009=\u2009131) were matched 1:4 with people who smoke tobacco cigarettes (n\u2009=\u2009524). Orthopaedic complications within 90\u2009days, 1\u2009year, and 2\u2009years were compared using multivariable logistic regressions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Within 90\u2009days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly higher rates of hardware removal (odds ratio [OR] 5.01, 95% CI 1.65-15.20), wound disruption or dehiscence (OR 3.00, 95% CI 1.21-7.44), and pooled complications (16.0% vs 5.9%, OR 2.84, 95% CI 1.50-5.38) compared with tobacco-na\u00efve controls. The rates of hardware removal, wound disruption and dehiscence, and pooled complications remained significant in the smokeless tobacco cohort at 1 and 2\u2009years. At 2\u2009years following ankle or hindfoot arthrodesis, smokeless tobacco users additionally demonstrated significantly higher rates of infection (OR 6.08, 95% CI 1.15-32.05) and nonunion (OR 2.35, 95% CI 1.31-4.20) compared with tobacco-na\u00efve controls. Within 90\u2009days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly lower rates of malunion or nonunion than patients who smoke tobacco cigarettes (OR 0.34, 95% CI 0.12-0.97), whereas all other complications were not significantly different.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Smokeless tobacco use is associated with higher rates of complications following ankle or hindfoot arthrodesis compared with tobacco-na\u00efve controls, and physicians should screen for smokeless tobacco use specifically and encourage cessation before operating electively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007241238213","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T08:48:01Z","timestamp":1711442881000},"page":"679-689","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of Smokeless Tobacco and Complications Following Ankle and Hindfoot Arthrodesis"],"prefix":"10.1177","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1591-0011","authenticated-orcid":false,"given":"Julianna E.","family":"Winter","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9016-4481","authenticated-orcid":false,"given":"Jacob S.","family":"Budin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bela P.","family":"Delvadia","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew W.","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy L.","family":"Waters","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam P.","family":"Schiff","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4097-5668","authenticated-orcid":false,"given":"William F.","family":"Sherman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,3,26]]},"reference":[{"key":"bibr1-10711007241238213","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2021.04.006"},{"key":"bibr2-10711007241238213","doi-asserted-by":"publisher","DOI":"10.1177\/1071100719867942"},{"key":"bibr3-10711007241238213","doi-asserted-by":"publisher","DOI":"10.1177\/003335491112600202"},{"key":"bibr4-10711007241238213","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1988.107"},{"key":"bibr5-10711007241238213","doi-asserted-by":"publisher","DOI":"10.7547\/0950034"},{"key":"bibr6-10711007241238213","unstructured":"Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 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