title: Smoking is Associated with Poorer Quality-Based Outcomes in Patients Hospitalized with Spinal Disease.
abstract: METHODS
  Retrospective cross-sectional database analysis.
  
  
  OBJECTIVE
  The cost of spine surgery is growing exponentially, and cost-effectiveness is a critical consideration. Smoking has been shown to increase hospital costs in general surgery, but this impact has not been reported in patients with spinal disease. The objective of this work was to evaluate the effect of smoking on cost and complications in a large sample of patients admitted for treatment of spinal disease.
  
  
  METHODS
  In 2012, the authors identified all inpatient admissions to all University HealthSystem Consortium (UHC) hospitals from 2005 to 2011 for spinal disease based on the principal diagnosis ICD-9-CM codes from the prospectively collected UHC database. Patient outcomes - including length of stay; complication, readmission, intensive care unit admission rates; and total cost - were compared for non-obese smokers and non-smokers using a two-sample t-test.
  
  
  RESULTS
  There were 137,537 patients, including 136,511 (122,608 non-smokers and 13,903 smokers) in the 4 largest diagnostic groups. Smoking was associated with increased complications and worse outcomes in three of these four groups. All outcomes in the two largest groups - fracture and dorsopathy - were worse in the smoking patients.
  
  
  CONCLUSIONS
  Smoking patients admitted for spinal disease in the sample had worse outcomes, increased complications, and higher costs than their non-smoking counterparts. In the current health-care climate focused on cost-effectiveness, smoking represents a potentially modifiable area for cost reduction.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.
authors.forename: Erica F
authors.initials: EF
authors.lastname: Bisson
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bowers
authors.affiliation: Comparative Data and Informatics Research, University HealthSystem Consortium , Chicago, IL , USA.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
keywords: healthcare costs; modifiable risk factors; patient outcomes; quality improvement; smoking; spine; surgery; value