The impact of current smoking and smoking cessation on short-term morbidity risk after lumbar spine surgery

Study Design. A retrospective review of prospectively collected data. Objective. The aim of this study was to determine the impact of current smoking or prior smoking cessation on 30-day morbidity risk following lumbar spine surgery. Summary of Background Data. Prior studies have reported conflicting data regarding the impact of smoking on morbidity risk, and few studies have investigated smoking cessation. Methods. A large, multicenter, prospectively collected clinical registry was queried for all adult patients undergoing lumbar spine surgery in 2012 and 2013, and 35,477 cases were identified. Morbidity data are collected by on-site clinical personnel for 30 days postoperatively. Patients were divided into categories of ''never-smoker,'' for patients with no reported cigarette use (n=27,246), ''former smoker,'' for patients who quit smoking more than 12 months before surgery (n=562), and ''current smoker,'' for patients still using cigarettes (n=7669). A univariate analysis was conducted to identify un-adjusted differences in morbidity risk, and a multivariate analysis was conducted in an attempt to control for confounders. Results. In the multivariate analysis, current smokers had a significantly higher risk of both superficial surgical site infection and overall wound complications, than never-smokers (P<0.05 for each). Current smokers also had a significantly higher risk of total 30-day morbidity (P=0.04). There was a trend toward former smokers also having an increased risk, but this did not reach significance in any category. Patients with a pack-year smoking history of 1 to 20 pack-years and more than 40 packyears both had a significantly higher risk of superficial surgical site infections (P<0.05 for each). Conclusion. Current smoking is associated with a small but significant increase in systemic morbidity and wound complications following elective lumbar spine procedures. Increasing pack year history was also associated with wound complication risk, suggesting a dose-related effect. The data provide preliminary support for future studies on smoking cessation.