title: Influence of smoking status at time of surgery for herniated lumbar disk on postoperative pain and health-related quality of life.
abstract: BACKGROUND
  It is well established that smoking has a myriad of negative effects on varies aspects of bodily health. The aim of this study was to examine the effects of the smoking status at time of surgery on the postoperative subjective pain course and health related quality of life (HRQoL) until 1 year after surgery for lumbar disc herniation (LDH).
  
  
  METHODS
  This prospective cohort study included patients ≥18 and ≤90 years of age with a symptomatic and radiological verified LDH. The current smoking patient collective (smoking 1 or more cigarettes a day) was compared with the nonsmoking collective (previous smokers without cigarette consumption for >2 months and never smokers) in respect of subjective pain sensation (measured with the visual analogue scale (VAS)) and HRQoL using the short-form (SF-12) questionnaire preoperatively, before discharge, as well as after 4 weeks and 1 year postoperatively. The primary outcome measures were the 1-year SF-12 scores (MCS and PCS) categorized into responders and non-responders.
  
  
  RESULTS
  A total of 102 patients were enrolled in the study. Thirty-eight patients were current smokers (37.2%), whereas 43 (42.2%) and 21 (20.6%) patients were never-smokers and previous smokers, respectively. Four weeks and one year after surgery, both smokers and nonsmokers reported increase in the HRQoL as compared to preoperative values - the MCS increased more than the PCS. From a univariate and multivariate perspective, smoking status at time of surgery did not predict responder status.
  
  
  CONCLUSIONS
  The present study results could not confirm the hypothesis that smoking at time of surgery was associated with worse outcome after surgery for LDH.
authors.affiliation: Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland. Electronic address: mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.affiliation: Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: Functional outcome; Health related quality of life; Lumbar disc herniation; Lumbar spine surgery; Multiple imputation; Smoking