PMID- 31415459
OWN - NLM
STAT- MEDLINE
DCOM- 20200317
LR  - 20210115
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 45
IP  - 1
DP  - 2020 Jan 1
TI  - The Effect of Tobacco Smoking on Adverse Events Following Adult Complex Deformity 
      Surgery: Analysis of 270 Patients From the Prospective, Multicenter Scoli-RISK-1 
      Study.
PG  - 32-37
LID - 10.1097/BRS.0000000000003200 [doi]
AB  - STUDY DESIGN: Post-hoc analysis of a prospective, multicenter cohort study. 
      OBJECTIVE: To analyze the impact of smoking on rates of postoperative adverse 
      events (AEs) in patients undergoing high-risk adult spine deformity surgery. 
      SUMMARY OF BACKGROUND DATA: Smoking is a known predictor of medical complications 
      after adult deformity surgery, but the effect on complications, implant failure 
      and other AEs has not been adequately described in prospective studies. METHODS: 
      Twenty-six patients with a history of current smoking were identified out of the 
      272 patients enrolled in the SCOLI-RISK-1 study who underwent complex adult 
      spinal deformity surgery at 15 centers, with 2-year follow-up. The outcomes and 
      incidence of AEs in these patients were compared to the nonsmoking cohort 
      (n = 244) using univariate analysis, with additional multivariate regression to 
      adjust for the effect of patient demographics, complexity of surgery, and other 
      confounders. RESULTS: The number of levels and complexity of surgery in both 
      cohorts were comparable. In the univariate analysis, the rates of implant failure 
      were almost double (odds ratio 2.28 [0.75-6.18]) in smoking group (n = 7; 26.9%)) 
      that observed in the nonsmoking group (n = 34; 13.9%), but this was not 
      statistically significant (P = 0.088). Surgery-related excessive bleeding (>4 L) 
      was significantly higher in the smoking group (n = 5 vs. n = 9; 19.2% vs. 3.7%; 
      OR 6.22[1.48 - 22.75]; P = 0.006). Wound infection rates and respiratory 
      complications were similar in both groups. In the multivariate analysis, the 
      smoking group demonstrated a higher incidence of any surgery-related AEs over 2 
      years (n = 13 vs. n = 95; 50.0% vs. 38.9%; OR 2.12 [0.88-5.09]) (P = 0.094). 
      CONCLUSION: In this secondary analysis of patients from the SCOLI-RISK-1 study, a 
      history of smoking significantly increased the risk of excessive intraoperative 
      bleeding and nonsignificantly increased the rate of implant failure or 
      surgery-related AEs over 2 years. The authors therefore advocate a smoking 
      cessation program in patients undergoing complex adult spine deformity surgery. 
      LEVEL OF EVIDENCE: 2.
FAU - Wilson, Jamie R F
AU  - Wilson JRF
AD  - University of Toronto Spine Program and Toronto Western Hospital, Toronto, 
      Ontario, Canada.
FAU - Jiang, Fan
AU  - Jiang F
AD  - University of Toronto Spine Program and Toronto Western Hospital, Toronto, 
      Ontario, Canada.
FAU - Badhiwala, Jetan H
AU  - Badhiwala JH
AD  - University of Toronto Spine Program and Toronto Western Hospital, Toronto, 
      Ontario, Canada.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - Department of Orthopaedic Surgery, Duke University, Durham, NC.
FAU - Carreon, Leah Y
AU  - Carreon LY
AD  - Norton Leatherman Spine Center, Louisville, KY.
FAU - Cheung, Kenneth M C
AU  - Cheung KMC
AD  - Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The 
      University of Hong Kong, Pokfulam, Hong Kong, China.
FAU - Dahl, Benny T
AU  - Dahl BT
AD  - Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
AD  - Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
FAU - Ames, Christopher P
AU  - Ames CP
AD  - Department of Neurosurgery and Orthopaedic Surgery, University of California, San 
      Francisco, San Francisco, CA.
FAU - Boachie-Adjei, Oheneba
AU  - Boachie-Adjei O
AD  - The FOCOS Hospital, Pantang West, Republic of Ghana.
FAU - Dekutoski, Mark B
AU  - Dekutoski MB
AD  - Marshfield Medical Center - Eau Claire Center, Eau Claire, WI.
FAU - Lewis, Stephen J
AU  - Lewis SJ
AD  - University of Toronto Spine Program and Toronto Western Hospital, Toronto, 
      Ontario, Canada.
FAU - Matsuyama, Yukihiro
AU  - Matsuyama Y
AD  - Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 
      Hamamatsu, Shizuoka, Japan.
FAU - Mehdian, Hossein
AU  - Mehdian H
AD  - The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham 
      University Hospitals, Nottingham, UK.
FAU - Pellise, Ferran
AU  - Pellise F
AD  - Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
FAU - Qiu, Yong
AU  - Qiu Y
AD  - Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, 
      Jiangsu, China.
FAU - Schwab, Frank J
AU  - Schwab FJ
AD  - Spine Service, Hospital for Special Surgery, New York, NY.
FAU - Lenke, Lawrence G
AU  - Lenke LG
AD  - The Och Spine Hospital at New York-Presbyterian, Columbia University Department 
      of Orthopaedic Surgery, New York, NY.
FAU - Fehlings, Michael G
AU  - Fehlings MG
AD  - University of Toronto Spine Program and Toronto Western Hospital, Toronto, 
      Ontario, Canada.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*etiology
MH  - Postoperative Period
MH  - Prospective Studies
MH  - Risk Factors
MH  - Spinal Curvatures/surgery
MH  - Tobacco Smoking/*adverse effects
MH  - Young Adult
EDAT- 2019/08/16 06:00
MHDA- 2020/03/18 06:00
CRDT- 2019/08/16 06:00
PHST- 2019/08/16 06:00 [pubmed]
PHST- 2020/03/18 06:00 [medline]
PHST- 2019/08/16 06:00 [entrez]
AID - 00007632-202001010-00009 [pii]
AID - 10.1097/BRS.0000000000003200 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2020 Jan 1;45(1):32-37. doi: 10.1097/BRS.0000000000003200.