The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Clinical article

Darryl Lau M.D., Dean Chou M.D., John E. Ziewacz M.D., M.P.H., and Praveen V. Mummaneni M.D.
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  • Department of Neurological Surgery, University of San Francisco, California
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Object

Smoking is one of the leading causes of preventable morbidity and death in the US and has been associated with perioperative complications. In this study, the authors examined the effects of smoking on perioperative outcomes and pseudarthrosis rates following anterior cervical corpectomy.

Methods

All adult patients from 2006 to 2011 who underwent anterior cervical corpectomy were identified. Patients were categorized into 3 groups: patients who never smoked (nonsmokers), patients who quit for at least 1 year (quitters), and patients who continue to smoke (current smokers). Demographic, medical, and surgical covariates were collected. Multivariate analysis was used to define the relationship between smoking and blood loss, 30-day complications, length of hospital stay, and pseudarthrosis.

Results

A total of 160 patients were included in the study. Of the 160 patients, 49.4% were nonsmokers, 25.6% were quitters, and 25.0% were current smokers. The overall 30-day complication rate was 20.0%, and pseudarthrosis occurred in 7.6% of patients. Mean blood loss was 368.3 ml and mean length of stay was 6.5 days. Current smoking status was significantly associated with higher complication rates (p < 0.001) and longer lengths of stay (p < 0.001); current smoking status remained an independent risk factor for both outcomes after multivariate logistic regression analysis. The complications that were experienced in current smokers were mostly infections (76.5%), and this proportion was significantly greater than in nonsmokers and quitters (p = 0.013). Current smoking status was also an independent risk factor for pseudarthrosis at 1-year follow-up (p = 0.012).

Conclusions

Smoking is independently associated with higher perioperative complications (especially infectious complications), longer lengths of stay, and higher rates of pseudarthrosis in patients undergoing anterior cervical corpectomy.

Abbreviations used in this paper:

BMI = body mass index; CI = confidence interval; COPD = chronic obstructive pulmonary disease; CVA = cerebrovascular accident; EBL = estimated blood loss; OR = odds ratio; TIA = transient ischemic attack.

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