Introduction: Although smoking substantially increases the risk of formation of intracranial aneurysms (ICA), rupture and vasospasm, the impact of smoking on the outcomes of craniotomy for ICA is unknown. The aim of this study was to assess the association between current and prior history of smoking and 30-day outcomes for patients undergoing craniotomy for ruptured and unruptured ICA.
Methods: We identified 478 adult patients in the 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a prospectively-collected, multi-institutional, clinical database with established validity and reproducibility. Using propensity scores, current and prior smokers were matched to never smokers. Logistic regression was used to predict adverse outcomes. The relationship between pack-years and adverse outcomes was also analyzed. Sensitivity analyses were conducted comparing patients with any smoking history with never smokers, and also limiting patient sample to single current procedural terminology (CPT) codes. This study was approved by University Hospitals of Cleveland Case Medical Center.
Results: In adjusted analyses, no association was found between smoking status and adverse outcomes. Prior smokers with more than 60 pack-years were more likely to have prolonged LOS (8.3, 95% CI, 1.4-48.5) compared to never smokers. Current or prior history of smoking was likewise not associated with poor outcomes when assessing patients with ruptured (n= 194, 41%) and unruptured ICA (n= 284, 59%) separately.
Conclusions: This is the first study to assess the effect of smoking on surgical outcomes for aneurysm. Using a large, prospectively-collected, multi-institutional, clinical database and carefully matching for a wide range of baseline characteristics, we found that neither smoking status at the time of surgery nor pack-years is associated with adverse outcomes. The results of this study suggest that surgical management of ICA, if not emergent, need not be delayed for smoking cessation.
Patient Care: Smoking has been linked to increased risk for development and rupture of ICA, which may be misinterpreted to mean that smokers have worst outcomes following ICA clipping. Our study suggests that smoking status per se is not a risk factor for adverse 30-day outcomes in surgical management of ICA. Thus, current or prior history of smoking should not deter neurosurgeons and patients from pursuing operative treatment of ICA.
Learning Objectives: By the conclusion of this session, the participants should be able to 1) relate the importance of using appropriate statistical methodology to isolate the effect of the primary variable of interest, smoking, 2) describe the relevance of smoking status and pack-year history on outcomes in patients undergoing craniotomy for ICA, 3) decrease reluctance in pursuing surgical treatment of ICA in smokers.