title: Effect of smoking on the perioperative outcomes of patients who undergo elective spine surgery.
abstract: METHODS
  Retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement database.
  
  
  OBJECTIVE
  We assessed whether preoperative cigarette smoking and smoking duration predicted adverse, early, perioperative outcomes in patients undergoing elective spine surgery.
  
  
  BACKGROUND
  Prior studies have assessed the association of smoking and long-term outcomes for a number of spine surgery procedures, with conflicting findings. The association between smoking and 30-day outcomes for spine surgery is unknown.
  
  
  METHODS
  A total 14,500 adults, classified as current (N = 3914), prior (N = 2057), and never smokers. Using propensity scores, current and prior smokers were matched to never smokers. Logistic regression was used to predict adverse postoperative outcomes. The relationship between pack-years and adverse outcomes was tested. Sensitivity analyses were conducted limiting the study sample to patients who underwent spine fusion (N = 4663), and using patient subgroups by procedure.
  
  
  RESULTS
  In unadjusted analyses, prior smokers were significantly more likely to have prolonged hospitalization (1.2, 95% confidence interval [CI]: 1.1-1.3) and major complications (1.3, 95% CI: 1.1-1.6) compared with never smokers. No association was found between smoking status and adverse outcomes in adjusted, matched patient models. Current smokers with more than 60 pack-years were more likely to die within 30 days of surgery (3.0, 95% CI, 1.1-7.8), compared with never smokers. Sensitivity analyses confirmed these findings.
  
  
  CONCLUSIONS
  The large National Surgical Quality Improvement population was carefully matched for a wide range of baseline comorbidities, including 29 variables previously suggested to influence perioperative outcomes. Although previous studies conducted in subgroups of spine surgery patients have suggested a deleterious effect for smoking on long-term outcomes in patients undergoing spine surgery, our analysis did not find smoking to be associated with early (30 d) perioperative morbidity or mortality.
authors: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA. aas33@case.edu
authors: Andreea
authors: A
authors: Seicean
authors: Sinziana
authors: S
authors: Seicean
authors: Nima
authors: N
authors: Alan
authors: Nicholas K
authors: NK
authors: Schiltz
authors: Benjamin P
authors: BP
authors: Rosenbaum
authors: Paul K
authors: PK
authors: Jones
authors: Duncan
authors: D
authors: Neuhauser
authors: Michael W
authors: MW
authors: Kattan
authors: Robert J
authors: RJ
authors: Weil
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D059035:Perioperative Period / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors