Schwartz AM, Farley KX, Boden SH, et al. - The present study was conducted to evaluate whether active smokers are at an elevated risk of poor medical and surgical outcomes after total shoulder arthroplasty (TSA). Between January 2011 and December 2015, researchers collected data for patients who had undergone arthroplasty of the shoulder in the USA from the National Readmission Database, and 90-day readmissions and complications were documented applying validated coding methods. They conducted the multivariate regression analysis to evaluate the risk of smoking on the outcome after TSA, while controlling for patient demographics, comorbidities, and hospital-level confounding factors. This research included a sum of 196,325 non-smokers (93.1%) and 14,461 smokers (6.9%) who had undergone TSA during the five-year study period. After TSA, smokers have an increased risk of readmission and medical and surgical complications. It was reported that these risks are similar to those found for smokers after hip and knee arthroplasty. In patients who smoke, many surgeons choose to avoid these elective procedures. The elevated risks should be recognized when counselling patients who smoke before undertaking TSA.