Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures

Zachary T Sharfman; Yaroslav Gelfand; Henry Hoang; Rafael De La Garza Ramos; Jaime A Gomez; Jonathan Krystal; David Kramer; Reza Yassari

doi:10.4103/jcvjs.jcvjs_15_22

Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures

J Craniovertebr Junction Spine. 2022 Apr-Jun;13(2):169-174. doi: 10.4103/jcvjs.jcvjs_15_22. Epub 2022 Jun 13.

Authors

Zachary T Sharfman¹, Yaroslav Gelfand², Henry Hoang¹, Rafael De La Garza Ramos², Jaime A Gomez¹, Jonathan Krystal¹, David Kramer¹, Reza Yassari²

Affiliations

¹ Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA.
² Department of Neurosurgery, Montefiore Medical Center, Bronx, New York, USA.

Abstract

Study design: This was retrospective cohort study.

Purpose: The current investigation uses a large, multi-institutional dataset to compare short-term morbidity and mortality rates between current smokers and nonsmokers undergoing thoracolumbar fusion surgery.

Overview of literature: The few studies that have addressed perioperative complications following thoracolumbar fusion surgeries are each derived from small cohorts from single institutions.

Materials and methods: A retrospective study was conducted on thoracolumbar fusion patients in the American College of Surgeons National Surgical Quality Improvement Program database (2006-2016). The primary outcome compared the rates of overall morbidity, severe postoperative morbidity, infections, pneumonia, deep venous thrombosis (DVT), pulmonary embolism (PE), transfusions, and mortality in smokers and nonsmokers.

Results: A total of 57,677 patients were identified. 45,952 (78.8%) were nonsmokers and 12,352 (21.2%) smoked within 1 year of surgery. Smokers had fewer severe complications (1.6% vs. 2.0%, P = 0.014) and decreased discharge to skilled nursing facilities (6.3% vs. 11.5%, P < 0.001) compared to nonsmokers. They had lower incidences of transfusions (odds ratio [OR] = 0.9, confidence interval [CI] = 0.8-1.0, P = 0.009) and DVT (OR = 0.7, CI = 0.5-0.9, P = 0.039) as well as shorter length of stay (LOS) (OR = 0.9, CI = 0.9-0.99, P < 0.001). They had a higher incidence of postoperative pneumonia (OR = 1.4, CI = 1.1-1.8, P = 0.002). There was no difference in the remaining primary outcomes between smoking and nonsmoking cohorts.

Conclusions: There is a positive correlation between smoking and postoperative pneumonia after thoracolumbar fusion. The incidence of blood transfusions, DVT, and LOS was decreased in smokers. Early postoperative mortality, severe complications, discharge to subacute rehabilitation facilities, extubation failure, PE, SSI, and return to OR were not associated with smoking.

Keywords: National surgical quality improvement program; postoperative period; smokers; smoking; thoracolumbar fusion.