STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: The aim of this study was to determine the impact of current smoking or prior smoking cessation on 30-day morbidity risk following lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Prior studies have reported conflicting data regarding the impact of smoking on morbidity risk, and few studies have investigated smoking cessation. METHODS: A large, multicenter, prospectively collected clinical registry was queried for all adult patients undergoing lumbar spine surgery in 2012 and 2013, and 35,477 cases were identified. Morbidity data are collected by on-site clinical personnel for 30 days postoperatively. Patients were divided into categories of "never-smoker," for patients with no reported cigarette use (n = 27,246), "former smoker," for patients who quit smoking more than 12 months before surgery (n = 562), and "current smoker," for patients still using cigarettes (n = 7669). A univariate analysis was conducted to identify un-adjusted differences in morbidity risk, and a multivariate analysis was conducted in an attempt to control for confounders. RESULTS: In the multivariate analysis, current smokers had a significantly higher risk of both superficial surgical site infection and overall wound complications, than never-smokers (P < 0.05 for each). Current smokers also had a significantly higher risk of total 30-day morbidity (P = 0.04). There was a trend toward former smokers also having an increased risk, but this did not reach significance in any category. Patients with a pack-year smoking history of 1 to 20 pack-years and more than 40 pack-years both had a significantly higher risk of superficial surgical site infections (P < 0.05 for each). CONCLUSION: Current smoking is associated with a small but significant increase in systemic morbidity and wound complications following elective lumbar spine procedures. Increasing pack year history was also associated with wound complication risk, suggesting a dose-related effect. The data provide preliminary support for future studies on smoking cessation. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: The aim of this study was to determine the impact of current smoking or prior smoking cessation on 30-day morbidity risk following lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Prior studies have reported conflicting data regarding the impact of smoking on morbidity risk, and few studies have investigated smoking cessation. METHODS: A large, multicenter, prospectively collected clinical registry was queried for all adult patients undergoing lumbar spine surgery in 2012 and 2013, and 35,477 cases were identified. Morbidity data are collected by on-site clinical personnel for 30 days postoperatively. Patients were divided into categories of "never-smoker," for patients with no reported cigarette use (n = 27,246), "former smoker," for patients who quit smoking more than 12 months before surgery (n = 562), and "current smoker," for patients still using cigarettes (n = 7669). A univariate analysis was conducted to identify un-adjusted differences in morbidity risk, and a multivariate analysis was conducted in an attempt to control for confounders. RESULTS: In the multivariate analysis, current smokers had a significantly higher risk of both superficial surgical site infection and overall wound complications, than never-smokers (P < 0.05 for each). Current smokers also had a significantly higher risk of total 30-day morbidity (P = 0.04). There was a trend toward former smokers also having an increased risk, but this did not reach significance in any category. Patients with a pack-year smoking history of 1 to 20 pack-years and more than 40 pack-years both had a significantly higher risk of superficial surgical site infections (P < 0.05 for each). CONCLUSION: Current smoking is associated with a small but significant increase in systemic morbidity and wound complications following elective lumbar spine procedures. Increasing pack year history was also associated with wound complication risk, suggesting a dose-related effect. The data provide preliminary support for future studies on smoking cessation. LEVEL OF EVIDENCE: 3.
Authors: Pascal Zehnder; Ulrike Held; Tim Pigott; Andrea Luca; Markus Loibl; Raluca Reitmeir; Tamás Fekete; Daniel Haschtmann; Anne F Mannion Journal: Eur Spine J Date: 2021-03-09 Impact factor: 3.134
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Authors: I David Kaye; Scott C Wagner; Joseph S Butler; Arjun Sebastian; Patrick B Morrissey; Christopher Kepler Journal: Int J Spine Surg Date: 2018-10-15
Authors: Austen David Katz; Dean Cosmo Perfetti; Alan Job; Max Willinger; Jeffrey Goldstein; Daniel Kiridly; Peter Olivares; Alexander Satin; David Essig Journal: Global Spine J Date: 2020-07-31
Authors: Dhruv K C Goyal; Srikanth N Divi; Daniel R Bowles; Victor E Mujica; I David Kaye; Mark F Kurd; Barrett I Woods; Kris E Radcliff; Jeffrey A Rihn; D Greg Anderson; Alan S Hilibrand; Christopher K Kepler; Alexander R Vaccaro; Gregory D Schroeder Journal: Global Spine J Date: 2020-05-29