The Potential Negative Effects of Smoking on Cervical and Lumbar Surgery beyond Pseudoarthrosis: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

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World Neurosurg


OBJECTIVE: The study was designed to review the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry to investigate the long-term associations between current smoking status and outcomes after elective cervical and lumbar spine surgery.

METHODS: Utilizing MSSIC we captured all cases from 01/01/17-11/21/20 with outcomes data available. 19,251 lumbar cases and 7,936 cervical cases were included. Multivariate regression analyses were performed to assess the relationship of smoking with the clinical outcomes.

RESULTS: Current smoking status was associated with lower urinary retention and satisfaction for lumbar surgery patients and was also associated with less likelihood of achieving minimal clinically important difference (MCID) in Patient-Reported Outcomes Measurement Information System (PROMIS), back pain, leg pain, and EQ5D at 90 days and 1 year after surgery. Current smokers were also less likely to return to work at 90 days and 1 year after surgery. For cervical patients, current smokers were less likely to have urinary retention and dysphagia postoperatively. They were less likely to be satisfied with the surgery outcome at 1 year. Current smoking was associated with lower likelihood of achieving MCID in PROMIS, neck pain, arm pain, and EQ5D at various time points. There was no difference in return-to-work status.

CONCLUSION: Our analysis suggests that smoking is negatively associated with functional improvement, patient satisfaction, and return-to-work after elective spine surgery.

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ePub ahead of print