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  • How Does Preoperative Smoking History Impact Anterior Cervical Discectomy and Fusion Outcomes?

    Final Number:

    Taylor Elise Purvis BA; Haroldo J. Rodriguez; Ali Karim Ahmed BS MD candidate; Christine Elizabeth Boone; Rafael De la Garza Ramos MD; C. Rory Goodwin MD PhD; Daniel M. Sciubba MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Studies that examine the relationship between preoperative smoking and morbidity following anterior cervical discectomy and fusion (ACDF) surgery are conflicting. No studies previously have used a national database to assess the impact of preoperative smoking on perioperative complications among ACDF patients. We sought to compare perioperative complication rates among current smokers, non-smokers, and ever-smokers undergoing ACDF surgery.

    Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for adults who underwent non-emergent ACDF surgery between 2005 and 2014. Preoperative smoking status—current smoker, non-smoker, or ever-smoker—was obtained. Variables analyzed included in-hospital mortality, development of a major complication, development of at least one complication, and length of hospital stay.

    Results: A total of 25,869 patients undergoing ACDF were identified; 7,847 (30.3%) current smokers, 18,022 (69.7%) not currently smoking, and 8542 (33.0%) ever-smokers. Current smokers did not have increased odds of developing any one complication (OR, 1.054; 95% CI, 0.874-1.271; P=0.584) or any major complication (OR, 1.233; 95% CI, 0.935-1.627; P=0.138). Ever-smokers did have higher odds of any major complication (OR, 1.333; 95% CI 1.007-1.764; P=0.044) than patients who had never smoked. The number of pack-years was not significantly associated with greater odds of developing any one complication (OR, 0.992; 95% CI, 0.978-1.006; P=0.276) or any major complication (OR, 0.991; 95% CI, 0.972-1.010; P=0.334).

    Conclusions: ACDF patients who smoke pre-operatively do not demonstrate higher rates of 30-day morbidity than patients not currently smoking. Patients who have ever smoked should be considered higher risk than never-smokers when undergoing ACDF.

    Patient Care: Clinicians will be able to identify patients with a positive smoking history who may be at increased risk for complications following ACDF.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the impact of preoperative smoking status on ACDF surgical outcomes; 2) Consider, in small groups, ways to discuss potential surgical risk with patients who have a positive ever-smoker status.


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