Retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement database.
We assessed whether preoperative cigarette smoking
and smoking duration predicted adverse, early, perioperative outcomes
in patients undergoing elective spine
Summary of Background Data.
Prior studies have assessed the association of smoking and long-term outcomes
for a number of spine
surgery procedures, with conflicting findings. The association between smoking and 30-day outcomes
surgery is unknown.
A total 14,500 adults, classified as current (N = 3914), prior (N = 2057), and never smokers. Using propensity scores, current and prior smokers were matched to never smokers. Logistic regression was used to predict adverse postoperative outcomes
. The relationship between pack-years and adverse outcomes
was tested. Sensitivity analyses were conducted limiting the study sample to patients who underwent spine
fusion (N = 4663), and using patient subgroups by procedure.
In unadjusted analyses, prior smokers were significantly more likely to have prolonged hospitalization (1.2, 95% confidence interval [CI]: 1.1–1.3) and major complications (1.3, 95% CI: 1.1–1.6) compared with never smokers. No association was found between smoking status and adverse outcomes
in adjusted, matched patient models. Current smokers with more than 60 pack-years were more likely to die within 30 days of surgery (3.0, 95% CI, 1.1–7.8), compared with never smokers. Sensitivity analyses confirmed these findings.
The large National Surgical Quality Improvement population was carefully matched for a wide range of baseline comorbidities, including 29 variables previously suggested to influence perioperative outcomes
. Although previous studies conducted in subgroups of spine
surgery patients have suggested a deleterious effect for smoking on long-term outcomes
in patients undergoing spine
surgery, our analysis did not find smoking to be associated with early (30 d) perioperative morbidity or mortality