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Spine (Phila Pa 1976). 2019 Aug 13. doi: 10.1097/BRS.0000000000003200. [Epub ahead of print]

The Effect of Tobacco Smoking on Adverse Events Following Adult Complex Deformity Surgery: Analysis of 270 Patients from The Prospective, Multi-center Scoli-RISK-1 study.

Author information

1
University of Toronto Spine Program and Toronto Western Hospital, Toronto, Ontario, Canada.
2
Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.
3
Norton Leatherman Spine Center, Louisville, Kentucky, USA.
4
Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
5
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
6
Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
7
Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
8
The FOCOS Hospital, Pantang West, Republic of Ghana.
9
Marshfield Medical Center - Eau Claire Center, Eau Claire, Wisconsin, USA.
10
Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
11
The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK.
12
Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
13
Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
14
Spine Service, Hospital for Special Surgery, New York, New York, USA.
15
The Och Spine Hospital at New York-Presbyterian, Columbia University Dept of Orthopaedic Surgery, New York, New York, USA.

Abstract

STUDY DESIGN:

Post-hoc analysis of a prospective, multi-center cohort study.

OBJECTIVE:

To analyze the impact of smoking on rates of postoperative adverse events (AEs) in patients undergoing high-risk adult spine deformity surgery.

SUMMARY OF BACKGROUND DATA:

Smoking is a known predictor of medical complications after adult deformity surgery, but the effect on complications, implant failure and other AEs has not been adequately described in prospective studies.

METHODS:

Twenty-six patients with a history of current smoking were identified out of the 272 patients enrolled in the SCOLI-RISK-1 study who underwent complex adult spinal deformity surgery at 15 centers, with 2 year follow up. The outcomes and incidence of AEs in these patients were compared to the non-smoking cohort (n = 244) using univariate analysis, with additional multivariate regression to adjust for the effect of patient demographics, complexity of surgery and other confounders.

RESULTS:

The number of levels and complexity of surgery in both cohorts were comparable. In the univariate analysis, the rates of implant failure were almost double (Odds Ratio 2.28 [0.75-6.18]) in smoking group (n = 7; 26.9%)) that observed in the non-smoking group (n = 34; 13.9%), but this was not statistically significant (p = 0.088). Surgery-related excessive bleeding (>4 liters) was significantly higher in the smoking group (n = 5 vs n = 9; 19.2% vs 3.7%; OR 6.22[1.48 - 22.75]; p = 0.006). Wound infection rates and respiratory complications were similar in both groups. In the multivariate analysis, the smoking group demonstrated a higher incidence of any surgery-related AEs over 2 years (n = 13 vs n = 95; 50.0% vs 38.9%; OR 2.12 [0.88-5.09]) (p = 0.094).

CONCLUSION:

In this secondary analysis of patients from the SCOLI-RISK-1 study, a history of smoking significantly increased the risk of excessive intra-operative bleeding and non-significantly increased the rate of implant failure or surgery-related AEs over 2 years. The authors therefore advocate a smoking cessation program in patients undergoing complex adult spine deformity surgery.

LEVEL OF EVIDENCE:

2.

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