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Tobacco Use Increases Risk of Medial Epicondylitis and Subsequent Surgical Intervention
Andrew Ardeljan, B.S.1,2, Joseph Palmer, D.O.3, Rushabh M Vakharia, M.D.1, Michael O Madden, D.O.4 and Martin W Roche, M.D.1, (1)Holy Cross Orthopedic Institute, Ft. Lauderdale, FL, (2)NSU College of Osteopathic Medicine, Davie, FL, (3)Broward General Medical Center, Ft. Lauderdale, FL, (4)University of Minnesota, Minneapolis, MN


INTRODUCTION: Medial epicondylitis (ME) can be painful and, in some cases, debilitating. Current risk factors for ME include forceful work, continuous bending or twisting of the wrist, or engaging in sports that require repetitive use of the common flexor tendon such as golf, tennis, and baseball. In most cases, ME is effectively treated non-operatively, but more serious cases may require surgical intervention. The purpose of this study is to investigate the relationship between tobacco use and development of ME, and its subsequent surgical repair.

METHODS: A Humana patient-population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision (ICD-9) and 10th Revision (ICD-10) codes. Patients with and without a history of tobacco use were queried using ICD-9 and ICD-10 codes for tobacco use disorder. The query resulted in a total of 3,315,620 patients. Tobacco and non-tobacco users were split into 2 matched cohorts of 1,657,810 patients each. Cohorts were matched by age, alcohol use, diabetes mellitus, gender, hyperlipidemia, hypertension, and obesity, successfully isolating tobacco use as an independent variable. Patients with ME were identified using ICD-9 code: 726.31, and ICD-10 code: M7700. Patients undergoing surgical intervention were identified using CPT codes 24358 and 24359. Patients with lateral epicondylitis were excluded. Logistic regression was used to calculate odds ratios (OR). A p-value less than 0.05 was considered statistically significant. 

RESULTS: After matching cohorts by comorbidities, the query yielded 10,884 patients with ME, 256 of which had undergone subsequent surgical intervention. Patients who used tobacco had increased odds of being diagnosed with ME (OR:1.05; 95%CI: 1.01 – 1.10, p=0.006), and even higher odds of undergoing surgical intervention for ME (OR:1.62; 95%CI: 1.25 – 2.08, p=0.0002).

CONCLUSION: Our results demonstrate that patients with a history of tobacco use have increased odds of developing ME and even higher odds of undergoing subsequent surgical intervention for ME, suggesting that tobacco use may increase the severity of ME. These results are consistent with the current literature on the harmful effects of tobacco on the musculoskeletal system and impairment of tendon healing.


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