STUDY DESIGN: Retrospective study. OBJECTIVE: To study the impact of smoking status on postoperative complications and pseudarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine. SUMMARY OF BACKGROUND DATA: Results of studies analyzing the impact of smoking on complication and pseudarthrosis rates after spine surgery are conflicting. METHODS: A retrospective medical record review was performed to identify all adult patients who underwent single- and 2-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and nonsmokers. The main outcome variables were development of at least one postoperative complication and development of pseudarthrosis. RESULTS: A total of 281 patients underwent single- or 2-level PLF in the 21-year period. Of these, 231 (82.21%) patients were nonsmokers and 50 (17.9%) were smokers. For patients undergoing single-level PLF, complication rates in nonsmokers (3.57%) versus smokers (7.69%) were not significantly different (P = 0.353); pseudarthrosis in nonsmokers occurred in 9.82% of cases compared with 7.69% in the smokers group (P = 0.738). Nonsmokers undergoing 2-level PLF had complication rates of 6.72%, compared with 4.17% in smokers (P = 0.638), but pseudarthrosis rates were significantly higher in the smokers group than in the nonsmokers group (29.17% vs. 10.92%; P = 0.019). Patients were followed up for an average of 53.5 months. CONCLUSION: The findings in this study suggest that smoking has a significant impact on pseudarthrosis rates after 2-level PLF of the lumbar spine, but not necessarily on single-level PLF. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Retrospective study. OBJECTIVE: To study the impact of smoking status on postoperative complications and pseudarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine. SUMMARY OF BACKGROUND DATA: Results of studies analyzing the impact of smoking on complication and pseudarthrosis rates after spine surgery are conflicting. METHODS: A retrospective medical record review was performed to identify all adult patients who underwent single- and 2-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and nonsmokers. The main outcome variables were development of at least one postoperative complication and development of pseudarthrosis. RESULTS: A total of 281 patients underwent single- or 2-level PLF in the 21-year period. Of these, 231 (82.21%) patients were nonsmokers and 50 (17.9%) were smokers. For patients undergoing single-level PLF, complication rates in nonsmokers (3.57%) versus smokers (7.69%) were not significantly different (P = 0.353); pseudarthrosis in nonsmokers occurred in 9.82% of cases compared with 7.69% in the smokers group (P = 0.738). Nonsmokers undergoing 2-level PLF had complication rates of 6.72%, compared with 4.17% in smokers (P = 0.638), but pseudarthrosis rates were significantly higher in the smokers group than in the nonsmokers group (29.17% vs. 10.92%; P = 0.019). Patients were followed up for an average of 53.5 months. CONCLUSION: The findings in this study suggest that smoking has a significant impact on pseudarthrosis rates after 2-level PLF of the lumbar spine, but not necessarily on single-level PLF. LEVEL OF EVIDENCE: 4.
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Authors: Peter G Passias; Cole Bortz; Haddy Alas; Frank A Segreto; Samantha R Horn; Yael U Ihejirika; Dennis Vasquez-Montes; Katherine E Pierce; Avery E Brown; Kartik Shenoy; Edward M DelSole; Bradley Johnson; Cheongeun Oh; Peter L Zhou; Chloe Deflorimonte; Ekhamjeet S Dhillon; Pawel P Jankowski; Bassel G Diebo; Virginie Lafage; Renaud Lafage; Shaleen N Vira; John A Bendo; Jeffrey A Goldstein; Frank J Schwab; Michael C Gerling Journal: J Orthop Date: 2018-12-20