Effects of smoking on cost and duration of hyperbaric oxygen therapy for diabetic patients with non-healing wounds.

During this study to determine the effects of smoking on diabetic patients undergoing hyperbaric oxygen therapy (HBO2T) for nonhealing wounds, one physician visited five hyperbaric facilities and reviewed records on 1,006 patients who had received HBO2T for diabetic wounds. Smoking history was documented on 469 patients, while 180 patients had complete information on number of HBO2Ts, outcome, age, duration of diabetes, transcutaneous oxygen baseline in air at ambient conditions, Wagner score of the worst wound, smoking history, and intensity of treatment. These factors were statistically significant predictors of treatment outcome using multiple regression modeling. No difference was found between smokers with less than 10 pack-years of cumulative history and nonsmokers. After that point there was a significant increase in the number of HBO2Ts needed to produce at least some healing in smokers vs. patients who had never smoked. The average patient with a greater than 10 pack-year smoking history who benefited from treatment was estimated to need between 8 and 14 more HBO2Ts. This translates into an added treatment cost of $4,000 to $7,000 for the average patient who has smoked, and an estimated $22-37 million annually for the United States.