PMID- 33774211
OWN - NLM
STAT- MEDLINE
DCOM- 20211027
LR  - 20211027
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 21
IP  - 8
DP  - 2021 Aug
TI  - The effect of smoking on achieving meaningful clinical outcomes one year after 
      lumbar tubular microdecompression: a matched-pair cohort analysis.
PG  - 1303-1308
LID - S1529-9430(21)00157-1 [pii]
LID - 10.1016/j.spinee.2021.03.020 [doi]
AB  - BACKGROUND CONTEXT: There has been a shift in the spine literature in reporting 
      meaningful outcomes, including meaningful clinically important difference (MCID), 
      after surgery. The evidence on the effect of tobacco smoking at the time of 
      lumbar tubular microdecompression (LTMD) on meaningful outcomes is limited. 
      PURPOSE: To compare differences in 1-year functional outcomes and rates of 
      achieving MCID between current smokers and non-smokers who underwent LTMD for 
      lumbar spinal stenosis (LSS). STUDY DESIGN: A nested case control study to 
      compare the difference in patient reported outcomes (PROs) between smokers and 
      non-smokers 1-year after undergoing LTMD. PATIENT SAMPLE: This study included 
      patients that underwent single level LTMD by a single surgeon between January 
      2014 through August 2019. OUTCOME MEASURES: Preoperative and postoperative PROs 
      were recorded using the questionnaires EQ-5D, Oswestry Disability Index (ODI), 
      and the visual analog scale (VAS) for back pain and leg pain. The MCID was also 
      used. METHODS: Current tobacco smokers at the time of surgery were matched 1:2 to 
      non-smokers by age (+/- 1year). Preoperative and postoperative functional scores 
      were compared between the two groups using independent t-tests. Additionally, 
      thresholds for achieving MCID were calculated for each individual functional 
      score, and were compared using Fisher's exact test. RESULTS: Of the 183 patients 
      with 1-year follow-up who met inclusion criteria, 35 patients were identified as 
      smokers and were matched to 70 non-smokers. No statistical differences were 
      identified between age, BMI, or gender. Comparison of preoperative PROs showed no 
      statistically significant differences between smokers and non-smokers (p>0.05 for 
      all), while smokers had statistically lower EQ-5D (p<0.001) and higher ODI 
      (p=0.05), VAS back (p=0.033), and VAS leg (p=0.03) score averages at a minimum of 
      one year follow-up. Evaluation of meaningful outcomes demonstrated non-smokers 
      had higher rates of achieving MCID on at least 1 threshold score as compared to 
      smokers (98.5% vs. 91.1%; p=0.043). CONCLUSIONS: Current smokers at the time of 
      surgery have inferior postoperative EQ-5D scores, increased pain and disability, 
      and lower odds of achieving the MCID at 1-year after undergoing LTMD when 
      compared to patients without any smoking history.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Beck, Edward C
AU  - Beck EC
AD  - Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center 
      Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA. 
      Electronic address: ecbeck@wakehealth.edu.
FAU - Gowd, Anirudh K
AU  - Gowd AK
AD  - Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center 
      Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
FAU - White, Jonathan C
AU  - White JC
AD  - Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center 
      Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
FAU - Knio, Ziyad O
AU  - Knio ZO
AD  - Department of Anesthesiology, University of Virginia Health System, 200 Jeanette 
      Lancaster Way Charlottesville, VA 22903, USA.
FAU - O'Gara, Tadhg J
AU  - O'Gara TJ
AD  - Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center 
      Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA; 
      Department of Neurosurgery , Wake Forest Baptist Health, Medical Center 
      Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
LA  - eng
PT  - Journal Article
DEP - 20210325
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Back Pain
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - *Disability Evaluation
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - *Smoking/adverse effects
MH  - Tobacco Smoking
MH  - Treatment Outcome
OTO - NOTNLM
OT  - 1-year outcomes
OT  - MCID
OT  - Microdecompression
OT  - Smoking
EDAT- 2021/03/29 06:00
MHDA- 2021/10/28 06:00
CRDT- 2021/03/28 20:42
PHST- 2020/12/14 00:00 [received]
PHST- 2021/02/05 00:00 [revised]
PHST- 2021/03/22 00:00 [accepted]
PHST- 2021/03/29 06:00 [pubmed]
PHST- 2021/10/28 06:00 [medline]
PHST- 2021/03/28 20:42 [entrez]
AID - S1529-9430(21)00157-1 [pii]
AID - 10.1016/j.spinee.2021.03.020 [doi]
PST - ppublish
SO  - Spine J. 2021 Aug;21(8):1303-1308. doi: 10.1016/j.spinee.2021.03.020. Epub 2021 
      Mar 25.