Introduction: Smoking has been shown to increase the risk of pseudoarthrosis after fusion and has been linked to complications after spinal surgery. However, it is unclear to what extent smoking status has on the development on wound infections in patients undergoing anterior cervical discectomy and fusion (ACDF).
Methods: Patients were identified by CPT (Current Procedural Terminology) code in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database.Patients were divided into those with and without current smoking history. Univariate (chi-square and Student t-test) analysis was performed on demographics, comorbidities and operative variables (including procedure subtypes). Only demographic and comorbidity variables with p<0.2 were evaluated for inclusion in the final step-wise multivariate logistic regression to determine if smoking was an independent risk factor for wound complications [Superficial Surgical Site infection (SSI), Deep SSI, Wound Dehiscence, Organ space SSI]. Level of significance was set at p=0.05.
Results: Smokers were more likely to fall into the age range of 18-64 years than their non-smoking counterparts (93.08% vs. 73.36%, p<0.0001). Non-smokers were diabetic (16.69%) more often than smokers (10.41%). As expected, smokers had an increased rate of pulmonary, cardiac and peripheral vascular comorbidities than non-smokers. With regards to multilevel fusions there were no difference between the two cohorts. There were no significant differences in complications between smokers and non-smokers. Multivariate analysis confirmed that smoking status was not a significant predictor of wound complications in patients undergoing ACDF.
Conclusions: Although smoking is associated with increased complication in surgery, it does not appear to increase the incidence of major 30-day complications, including wound infections in patients undergoing ACDF.
Patient Care: Understanding the potential risks of smoking on patients undergoing ACDF can help better stratify patients based on risk prior to surgery.
Learning Objectives: By the conclusion of this session, participants should be able to understand the potential risks of smoking on patients undergoing ACDF.