What Is the Impact of Smoking on Patient-Reported Outcomes Following Posterior Cervical Decompression and Fusion?

Gregory R Toci; Brian A Karamian; Mark J Lambrechts; Jennifer Mao; David Reiter; Samuel Alfonsi; Teleale Fikru; Jose A Canseco; Mark F Kurd; Barrett I Woods; I David Kaye; Alan S Hilibrand; Christopher K Kepler; Alexander R Vaccaro; Gregory D Schroeder

doi:10.1016/j.wneu.2022.03.003

What Is the Impact of Smoking on Patient-Reported Outcomes Following Posterior Cervical Decompression and Fusion?

World Neurosurg. 2022 Jun:162:e319-e327. doi: 10.1016/j.wneu.2022.03.003. Epub 2022 Mar 5.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
² Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: mark.lambrechts@rothmanortho.com.

PMID: 35259508
DOI: 10.1016/j.wneu.2022.03.003

Abstract

Objective: The purpose of this retrospective cohort study was to investigate the impact of smoking on patient-reported outcome measures (PROMs) following elective posterior cervical decompression and fusion (PCF).

Methods: Electronic medical records at a single institution were reviewed for patients undergoing elective PCF. Patients were grouped based on smoking history: current smokers, former smokers, and never smokers. A delta score (Δ) was calculated for all PROMs (postoperative minus preoperative scores). Continuous and categorical data were compared using analysis of variance or χ² tests. Regression analysis controlled for demographics. Patients were then regrouped into current smokers and nonsmokers for reanalysis.

Results: A total of 195 patients were included, of whom 35 (22.1%) were current smokers, 51 (26.2%) were former smokers, and 101 (51.8%) were never smokers. Preoperative and postoperative Short-Form 12 Mental Component Score (MCS-12) were significantly lower in the current smoker group (preoperative: current 42.7, former 49.9, and never 46.6; P = 0.024; postoperative: current 44.6, former 53.7, and never 52.2; P = 0.003). Only never smokers improved in MCS-12 and Neck Disability Index following surgery. On regrouping, current smokers had significantly lower preoperative MCS-12 (42.7 vs. 47.7, P = 0.031), lower preoperative modified Japanese Orthopaedic Association (12.2 vs. 14.0, P = 0.039), greater preoperative visual analog scale Arm (6.39 vs. 4.94, P = 0.025), and lower postoperative MCS-12 (44.6 vs. 52.7, P = 0.001). Only the nonsmokers improved in MCS-12 and Neck Disability Index following surgery. On regression analysis, smoking was not an independent predictor of ΔPROMs.

Conclusions: Univariate analysis found that smokers have worse symptoms at baseline. However, smoking status was not an independent predictor of improvement in ΔPROMs following elective PCF.

Keywords: Clinical outcomes; Patient-reported outcome measures; Posterior cervical fusion; Quality of life; Smokers; Smoking.

MeSH terms

Cervical Vertebrae / surgery
Decompression
Humans
Patient Reported Outcome Measures
Retrospective Studies
Smoking / epidemiology
Spinal Fusion*
Treatment Outcome