The Effect of Tobacco Smoking on Adverse Events Following Adult Complex Deformity Surgery: Analysis of 270 Patients From the Prospective, Multicenter Scoli-RISK-1 Study

Jamie R F Wilson, Fan Jiang, Jetan H Badhiwala, Christopher I Shaffrey, Leah Y Carreon, Kenneth M C Cheung, Benny T Dahl, Christopher P Ames, Oheneba Boachie-Adjei, Mark B Dekutoski, Stephen J Lewis, Yukihiro Matsuyama, Hossein Mehdian, Ferran Pellisé, Yong Qiu, Frank J Schwab, Lawrence G Lenke, Michael G Fehlings

10 Citationer (Scopus)

Abstract

STUDY DESIGN: Post-hoc analysis of a prospective, multicenter 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 nonsmoking 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 nonsmoking group (n = 34; 13.9%), but this was not statistically significant (P = 0.088). Surgery-related excessive bleeding (>4 L) 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 intraoperative bleeding and nonsignificantly 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.

OriginalsprogEngelsk
TidsskriftSpine
Vol/bind45
Udgave nummer1
Sider (fra-til)32-37
Antal sider6
ISSN0362-2436
DOI
StatusUdgivet - 1 jan. 2020

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