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The Capital Region of Denmark - a part of Copenhagen University Hospital
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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

Research output: Contribution to journalJournal articleResearchpeer-review

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  • 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
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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.

Original languageEnglish
JournalSpine
Volume45
Issue number1
Pages (from-to)32-37
Number of pages6
ISSN0362-2436
DOIs
Publication statusPublished - 1 Jan 2020

    Research areas

  • Adult, Aged, Cohort Studies, Female, Humans, Incidence, Male, Middle Aged, Postoperative Complications/etiology, Postoperative Period, Prospective Studies, Risk Factors, Spinal Curvatures/surgery, Tobacco Smoking/adverse effects, Young Adult

ID: 62385915