Smoking is a modifiable risk factor for complications following total knee arthroplasty (TKA). It is unclear if the declining prevalence of tobacco use in the U.S. population is reflected in patients undergoing elective TKA. This study aims to investigate (1) the incidence of 30-day complications following TKA in smokers and (2) trends in preoperative smoking status among TKA patients. In this study, patients undergoing primary elective TKA in the United States from 2011 to 2019 were identified in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database. Our cohort included 406,553 cases, 8.13% of which had smoked cigarettes within 1 year of undergoing TKA. Smokers were propensity score-matched to a group of nonsmokers, with each n = 32,533. The incidences of 30-day complications, readmission, and non-home discharge were compared between groups. The rate of preoperative smoking among elective primary TKA patients remained stagnant from 2011 to 2019. Smokers had higher rates of superficial surgical site infections (SSIs; 1.1 vs. 0.5%, p < 0.001), deep SSI (0.3 vs. 0.2%, p = 0.012), wound disruption (0.4 vs. 0.2%, p < 0.001), pneumonia (0.5 vs. 0.3%, p < 0.001), and 30-day readmission (3.6 vs. 2.7%, p < 0.001) compared with nonsmokers. No significant trends in 30-day complications were noted between 2011 and 2019. This study supports the success of national efforts to reduce the prevalence of smoking and reports a modest effect within the TKA population. However, almost 1 in 10 patients undergoing elective TKA continues to smoke and maintains a higher risk of postoperative complications.

吸烟是全膝关节置换术（TKA）后并发症的一个可改变的危险因素。目前尚不清楚美国人口中烟草使用率的下降是否反映在接受选择性全膝关节置换术的患者身上。本研究旨在调查 (1) 吸烟者 TKA 后 30 天并发症的发生率以及 (2) TKA 患者术前吸烟状况的趋势。在这项研究中，美国外科医生学会国家手术质量改进计划 (ACS-NSQIP) 数据库中确定了 2011 年至 2019 年在美国接受初次择期 TKA 的患者。我们的队列包括 406,553 例病例，其中 8.13% 在接受 TKA 后 1 年内吸烟。吸烟者与一组非吸烟者进行倾向评分匹配，每组n = 32,533。比较各组之间 30 天并发症、再入院和非回家出院的发生率。2011 年至 2019 年，择期初次 TKA 患者的术前吸烟率保持停滞状态。吸烟者的浅表手术部位感染率较高（SSIs；1.1 vs. 0.5%，p < 0.001），深部SSI  （0.3 vs. 0.2%，p）  = 0.012）、伤口破裂（0.4 vs. 0.2%，p  < 0.001）、肺炎（0.5 vs. 0.3%，p  < 0.001）和 30 天再入院（3.6 vs. 2.7%，p < 0.001）与不吸烟者相比。2011 年至 2019 年间，没有发现 30 天并发症的显着趋势。这项研究支持了国家努力减少吸烟率的成功，并报告在 TKA 人群中取得了一定的效果。然而，近十分之一接受择期 TKA 的患者继续吸烟，术后并发症的风险较高。