The Effect of Cigarette Smoking on Wound Complications After Single-Level Posterolateral and Interbody Fusion for Spondylolisthesis

Echt, Murray; Ramos, Rafael De la Garza; Nakhla, Jonathan; Gelfand, Yaroslav; Cezayirli, Phillip; Holland, Ryan; Kinon, Merritt D.; Yassari, Reza

doi:10.1016/j.wneu.2018.05.103

Cited by 13 publications

(19 citation statements)

References 26 publications

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“…11,12 Furthermore, in the spine literature, tobacco use has been associated with increased rates of pseudoarthrosis, infection, and wound complications. [13][14][15][16] Readmission is an important measure of patient outcome and hospital performance, and hospitals maybe be penalized for higher-than-average readmission rates through the Hospital Readmission Reduction Program (HRRP). 17 Accordingly, increasing attention has been paid to understand factors associated with readmission and to develop strategies to reduce readmission.…”

Section: Introductionmentioning

confidence: 99%

Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease

Connor

Briggs

Bonney

et al. 2020

Global Spine Journal

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Study Design: Retrospective database study. Objective: Tobacco use is associated with complications after surgical procedures, including poor wound healing, surgical site infections, and cardiovascular events. We used the Nationwide Readmissions Database (NRD) to determine if tobacco use is associated with increased 30- and 90-day readmission among patients undergoing surgery for degenerative spine disorders. Methods: Patients who underwent elective spine surgery were identified in the NRD from 2010 to 2014. The study population included patients with degenerative spine disorders treated with discectomy, fusion, or decompression. Descriptive and multivariate logistic regression analyses were performed to identify patient and hospital factors associated with 30- and 90-day readmission, with significance set at P value <.001. Results: Within 30 days, 4.8% of patients were readmitted at a median time of 9 days. The most common reasons for 30-day readmission were postoperative infection (12.5%), septicemia (3.5%), and postoperative pain (3.0%). Within 90 days, 7.3% were readmitted at a median time of 18 days. The most common reasons for 90-day readmission were postoperative infection (9.6%), septicemia (3.5%), and pneumonia (2.3%). After adjustment for patient and hospital characteristics, tobacco use was independently associated with readmission at 90 days (odds ratio 1.05, 95% confidence interval 1.03-1.07, P < .0001) but not 30 days (odds ratio 1.02, 95% confidence interval 1.00-1.05, P = .045). Conclusions: Tobacco use is associated with readmission within 90 days after cervical and thoracolumbar spine surgery for degenerative disease. Tobacco use is a known risk factor for adverse health events and therefore should be considered when selecting patients for spine surgery.

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Section: Introductionmentioning

confidence: 99%

Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease

Connor

Briggs

Bonney

et al. 2020

Global Spine Journal

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“…also assessed the impact of smoking on SSI/wound complications (superficial/deep/other) at 1 postoperative month for 1688 patients (e.g., identified by the American College of Surgeons National Surgical Quality Improvement Program database 2012–2014). [9] Spine operations included one-level posterolateral and interbody fusions for degenerative spondylolisthesis. They identified 271 smokers (16.1%) undergoing interbody fusions who demonstrated a higher incidence of wound complications.…”

Section: Introductionmentioning

confidence: 99%

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Epstein¹

2018

Surg Neurol Int

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Background: Multiple measures prior to spine surgery may reduce the risks of postoperative surgical site infections (SSIs). Methods: The incidence of SSI following spinal surgery (including reoperations and readmissions) may be markedly reduced by performing less extensive procedures and avoiding fusion where feasible. Preoperative testing up to 3 weeks postoperatively should include other studies to limit the perioperative SSI risk; cardiac stress tests (e.g., older patients/cardiac comorbidities), starting tamsulosin in males over 60 (e.g. avoid urinary retention due to benign prostatic hypertrophy), albumin/prealbumin levels (e.g., low levels increase SSI risk), and HBA1C levels to identify new/treat known diabetics (normalize/reduce preoperative levels). Results: Other measures include the timely administration of preoperative antibiotics (e.g., cefazolin 2 g nonpenicillin allergic), one dose of gentamicin (adjusted dose/weight), nasal cultures for methicillin-resistant Staphylococcus aureus (patients/health-care workers), and bathing 2 weeks preoperatively with chlorhexidine gluconate 4% (not just night before/morning of surgery). Additionally, prior to surgery, the following medications that increase the bleeding risk should be stopped (e.g. for varying periods); anticoagulants, antiplatelet therapies (e.g., aspirin for at least 7–10 days), nonsteroidal anti-inflammatories (NSAIDS: timing depends on the drug), vitamin E, and herbal supplements. Additionally, avoiding elective spinal surgery in morbidly obese patients and recognizing other major medical contraindications to spinal surgery should help reduce infection, morbidity, and mortality rates. Conclusions: Appropriate preoperative and intraoperative prophylactic maneuvers may reduce the risk of postoperative spinal SSI. Specific attention to these details may avoid infections and improve outcomes.

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“…This had been well reported in lumbar spinal fusion surgery with an increased rate of pseudoarthrosis, occurring up to four times in smokers compared with nonsmokers after lumbar spinal fusion. [3][4][5][6] Hilibrand and colleagues demonstrated poorer clinical outcomes among smokers when compared with nonsmokers in anterior cervical decompression and fusion. They postulated that the poorer outcomes were because of fusion-related complications as they found a strong association between the development of pseudoarthrosis and poor clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Does Cigarette Smoking Affect Cervical Laminoplasty Clinical and Radiologic Outcomes?

Liu¹,

Tan²,

Tan

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Study design: Retrospective review. Objective: This study aimed to investigate if smokers have both poorer early clinical and radiologic outcomes in cervical laminoplasty when compared with nonsmokers. Summary of Background Data: Cigarette smoking had been reported to increase rates of pseudoarthrosis following spinal instrumentation with fusion. Methodology: A retrospective review of all patients who underwent open-door cervical laminoplasty was performed. Nurick, neck pain visual analog scale, and neck disability index scores were reviewed. Cervical lordosis, range of motion (ROM), and intervertebral disc height were measured. The rates and reasons for revision surgery were recorded and classified according to the etiology of laminoplasty revision surgery. Results: Sixty patients were recruited, of which 20 patients (18 males, 2 females) were smokers and 40 patients (27 males, 13 females) were nonsmokers. There was no statistically significant difference between smokers and nonsmokers in preoperative and postoperative visual analog scale, neck disability index, and Nurick scores. A trend was noted toward a greater postoperative reduction in cervical lordosis (13±8 vs. 11±11 degrees). Furthermore, 41% of smokers versus 30% in nonsmokers had >10% loss of postoperative ROM, and 59% smokers versus 50% nonsmokers had >5% loss of postoperative ROM. Postoperative complications and intervertebral disc deterioration were similar in both groups. A higher reoperation rate was noted in smokers with 6 smokers (30%) as compared with 4 nonsmokers (10%), although this did not reach statistical significance. Among the smokers, 4 (20%) were because of cervical disease progression while 2 were technique related. In nonsmokers, all 4 (10%) were because of cervical disease progression. Conclusion: This study showed that while there was a nonstatistically significant trend noted toward higher rates of revision surgery in smokers, the laminoplasty outcomes were not significantly poorer in smokers. In heavy smokers with multilevel cervical myelopathy, laminoplasty may be the treatment of choice over anterior spinal decompression and fusion where a high risk of pseudoarthrosis is anticipated.

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The Effect of Cigarette Smoking on Wound Complications After Single-Level Posterolateral and Interbody Fusion for Spondylolisthesis

Cited by 13 publications

References 26 publications

Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease

Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Does Cigarette Smoking Affect Cervical Laminoplasty Clinical and Radiologic Outcomes?

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