Does Smoking Status Influence Health-Related Quality of Life Outcome Measures in Patients Undergoing ACDF?

Abstract

Study design: Retrospective comparative study. Objective: Whereas smoking has been shown to affect the fusion rates for patients undergoing an anterior cervical discectomy and fusion (ACDF), the relationship between smoking and health-related quality of life outcome measurements after an ACDF is less clear. The purpose of this study was to evaluate whether smoking negatively affects patient outcomes after an ACDF for cervical degenerative pathology.Methods: Patients with tumor, trauma, infection, and previous cervical spine surgery and those with less than a year of follow-up were excluded. Smoking status was assessed by self-reported smoking history. Patient outcomes, including Neck Disability Index, Short Form 12 Mental Component Score, Short Form 12 Physical Component Score (PCS-12), Visual Analogue Scale (VAS) arm pain, VAS neck pain, and pseudarthrosis rates were evaluated. Outcomes were compared between smoking groups using multiple linear and logistic regression, controlling for age, sex, and body mass index (BMI), among other factors. A P value <.05 was considered significant.Results: A total of 264 patients were included, with a mean follow-up of 19.8 months, age of 53.1 years, and BMI of 29.6 kg/m2. There were 43 current, 69 former, and 152 nonsmokers in the cohort. At baseline, nonsmokers had higher PCS-12 scores than current smokers (P ¼ .010), lower VAS neck pain than current (P ¼ .035) and former (P ¼ .014) smokers, as well as lower VAS arm pain than former smokers (P ¼ .006). Postoperatively, nonsmokers had higher PCS-12 scores than both current (P ¼ .030) and former smokers (P ¼ .035). Smoking status was not a significant predictor of change in patient outcome in multivariate analysis.Conclusions: Whereas nonsmokers had higher function and lower pain than former or current smokers preoperatively, smoking status overall was not found to be an independent predictor of outcome scores after ACDF. This supports the notion that smoking status alone should not deter patients from undergoing ACDF for cervical degenerative pathology.

Relationship between smoking and postoperative complications of cervical spine surgery: a systematic review and meta-analysis

“…The number of patients who underwent reoperation was provided in eight studies 4 , 11 – 13 , 20 , 41 , 46 , 49 . Significant heterogeneity was observed, and a random-effects model was used (I 2 = 57.7%, p = 0.020).…”

“…Pooling of the results demonstrated that smokers were more associated with reoperation than nonsmokers (ES = 1.80, 95% CI: 1.06–3.06, p = 0.0029). When performing statistical analysis of Mangan et al 46 , we defined the sum of current and former smokers as the total number of smokers. We then removed Mangan et al, performed a sensitivity analysis, and found that heterogeneity was reduced to 41.4% (Fig.…”

Influence of Preoperative Smoking Status on Clinical Outcomes of Laminoplasty in Patients With Degenerative Cervical Myelopathy: a Prospective Study

“…Previous studies have demonstrated that smoking status negatively impacted the overall clinical outcomes of anterior cervical spine surgery, mainly the recovery of nerve function. However, the effect of smoking on the success rate of fusion is still under debate, although most studies concluded that smoking status did not affect the fusion rate [17,18,20,40]. The effect of smoking on the clinical outcomes of posterior approach cervical surgery remains controversial, with some studies have shown that smoking adversely affects clinical outcomes after posterior cervical fusion [22,41].…”

Impact of Smoking On Surgical Outcomes For Patients Undergoing Cervical Surgery: A Systematic Review And Meta-Analysis

“…The number of patients who underwent reoperation was provided in eight studies 4,[11][12][13]20,42,47,50 . Signi cant heterogeneity was observed, and a randomeffects model was used (I²=58%, p=0.02).…”

“…Pooling of the results demonstrated that the incidence of reoperation in the smoking group was signi cantly higher than that of the non-smoking group (OR=1.94, 95% CI: 1.0-3.80, p=0.05). When performing statistical analysis of Mangan et al 47 , we de ned the sum of current and former smokers as the total number of smokers. We then removed Mangan et al, performed a sensitivity analysis, and found that heterogeneity was reduced to 39% (Fig.…”