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Impact of Smoking on 30-day Morbidity and Mortality in Adult Spinal Deformity Surgery

De la Garza Ramos, Rafael MD; Goodwin, Courtney Rory MD, PhD; Qadi, Mohamud BS; Abu-Bonsrah, Nancy BS; Passias, Peter G. MD; Lafage, Virginie PhD; Schwab, Frank MD; Sciubba, Daniel M. MD

doi: 10.1097/BRS.0000000000001795

Study Design. A retrospective cohort study of a prospectively collected surgical database.

Objective. The aim of this study was to investigate the effect of smoking on 30-day morbidity and mortality in patients undergoing surgery for adult spinal deformity (ASD).

Summary of Background Data. There is conflicting evidence regarding the impact of smoking on short-term outcomes after spinal fusion.

Methods. A retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement database was performed for the years 2007 to 2013. Patients who underwent spinal fusion for ASD were identified. Thirty-day morbidity and mortality were compared between current smokers and nonsmokers. The independent effect of smoking was investigated via multivariate logistic regression analysis.

Results. A total of 1368 patients met inclusion criteria and were included in this study. Of the 1368 patients, 15.9% were smokers and 84.1% nonsmokers. The proportion of smokers who developed at least one complication was 9.7% versus 13.6% for nonsmokers (P = 0.119). Major complication rates (including 30-day mortality) were 6.5% for smokers and 8.4% for nonsmokers (P = 0.328). Current smoking status was not associated with increased odds of developing any complication [odds ratio (OR) 0.90; 95% confidence interval (95% CI), 0.47–1.71; P = 0.752] or major complications (OR 1.32; 95% CI 0.64–2.70; P = 0.447) after multivariate analysis.

Conclusion. Smoking was not associated with higher 30-day complications or mortality after corrective surgery for ASD in this study. However, given the negative effects of smoking on overall health and spine surgery outcomes in the long term, smoking cessation before spinal fusion is still recommended.

Level of Evidence: 3

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

Division of Spinal Surgery, NYU Medical Center-Hospital for Joint Diseases, New York City, New York

Spine Surgery, Hospital for Special Surgery, New York, New York.

Address correspondence and reprint requests to Daniel M. Sciubba, MD, The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287. E-mail:

Received 23 March, 2016

Revised 23 May, 2016

Accepted 30 June, 2016

Rafael De la Garza Ramos and C. Rory Goodwin contributed equally to this manuscript.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, stocks, payment for lectures.

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