title: Smoking as an independent predictor of reoperation after lumbar laminectomy: a study of 500 cases.
abstract: OBJECTIVE
  This study aimed to identify the factors predicting an increased risk for reoperation in patients who had undergone a lumbar laminectomy.
  
  
  METHODS
  The authors retrospectively reviewed the electronic medical records of all patients who had undergone firsttime, bilateral laminectomy at 1, 2, or 3 levels for lumbar spondylosis at the authors' institution. Patients who underwent fusion, laminotomy, discectomy, or complete facetectomy were excluded. The patients' preoperative symptoms and comorbidities were also obtained from their medical records.
  
  
  RESULTS
  Over an average follow-up period of 46.8 months, of 500 patients who had undergone laminectomy at 1, 2, or 3 levels, 81 patients (16.2%) developed subsequent spinal disorders that required a reoperation. A multiple logistic regression analysis identified smoking as an independent predictor of reoperation (OR 2.15, p = 0.01). Smoking was also an independent predictor of reoperation after a single-level laminectomy (OR 11.3, p = 0.02) and after a multilevel (that is, involving 2 or 3 levels) laminectomy (OR 1.98, p = 0.05). For 72 patients undergoing reoperation only for spinal degeneration, smoking remained an independent, statistically significant predictor of reoperation (OR 2.06, p = 0.04). Nine patients underwent reoperation for nondegenerative conditions (hematoma, wound infection, or wound dehiscence), and in these patients, chronic obstructive pulmonary disease was the only statistically significant predictor of reoperation (OR 8.92, p = 0.03).
  
  
  CONCLUSIONS
  Smoking was the strongest predictor of reoperation in patients who had undergone single-level laminectomy, multilevel laminectomy, or reoperation for progression of spinal degeneration. These findings suggest that smokers have worse outcomes of lumbar decompression than nonsmokers.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine; and.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.forename: Mohamed
authors.initials: M
authors.lastname: Macki
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
mesh_terms: D019299:Decompression, Surgical / Q000379:methods; D017586:Diskectomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000601:surgery; D016896:Treatment Outcome
keywords: COPD = chronic obstructive pulmonary disease; decompression; laminectomy; lumbar; predictor; reoperation; smoking; spinal disorders