Vaping and Orthopedic Surgery: Perioperative Management

The growing use of electronic cigarettes (ECs) as a perceived safer alternative to traditional combustible smoking has significant implications for orthopedic surgery patients. Surgeons need to recognize the harms and risks associated with ECs beyond their nicotine content. EC aerosols contain cytotoxic elements, including harmful chemicals, carcinogens, heavy metals, and flavoring agents. They can induce oxidative stress, resulting from an imbalance between cell antioxidant defense and reactive oxygen species (ROS). These effects can compromise bone repair, particularly with skeletal system disorders. Furthermore, ECs’ impact on wound healing and surgical site infection (SSI) have been well-documented. Smoking can reduce the inflammatory healing response, impair oxidative bacterial killing mechanisms, delay the proliferation healing response, and alter collagen metabolism. Some surgical practices remain unchanged despite physicians’ efforts to inquire about EC use. Most orthopedic surgeons do not delay surgery due to nicotine consumption, and urine tests for nicotine are rarely used. However, preoperative smoking cessation interventions offer a unique opportunity to help patients stop consuming nicotine. Therefore, it is crucial for orthopedic surgeons to understand the harms of ECs and communicate the associated risks to patients.