TY - JOUR
T1 - Impact of Tobacco Smoking on Outcomes after Posterior Decompression Surgery in Patients with Cervical Spondylotic Myelopathy
T2 - A Retrospective Multicenter Study
AU - Nagoshi, Narihito
AU - Kono, Hitoshi
AU - Tsuji, Osahiko
AU - Aoyama, Ryoma
AU - Fujiyoshi, Kanehiro
AU - Shiono, Yuta
AU - Ishikawa, Masayuki
AU - Daimon, Kenshi
AU - Hosogane, Naobumi
AU - Takeuchi, Ayano
AU - Okada, Eijiro
AU - Fujita, Nobuyuki
AU - Yagi, Mitsuru
AU - Nakamura, Masaya
AU - Matsumoto, Morio
AU - Watanabe, Kota
AU - Ishii, Ken
AU - Yamane, Junichi
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Study Design:This was a case-control study.Objective:The objective of this study was to clarify the surgical outcomes after cervical posterior decompression in patients who smoked.Summary of Background Data:Smoking is associated with poor outcomes in the field of spinal surgery. However, the impact of tobacco smoking on the outcomes after posterior decompression surgery has not been fully evaluated in patients with cervical spondylotic myelopathy.Materials and Methods:In this retrospective multicenter study, 587 patients with cervical spondylotic myelopathy were enrolled at 17 institutions in Japan. Patients underwent cervical laminoplasty or laminectomy and were followed up for at least 1 year after surgery. Outcome measures were: preoperative smoking status, perioperative complications, the Japanese Orthopedic Association scale, and the Visual Analog Scale for neck pain. After adjusting for age and sex by exact matching, smoking and nonsmoking groups were compared using an unpaired t test for continuous variables or a χ2test for categorical variables.Results:There were 182 (31%) current smokers and 405 (69%) nonsmokers including previous smokers. After matching, 158 patients were extracted from each group. Demographic data and surgical information were almost the same between the groups. Regarding postoperative complications, there was no significant difference in the rate of surgical site infection, cerebrospinal fluid leakage, hematoma, segmental motor paralysis, or neurological deficit. However, smokers showed a significantly higher risk for delirium (3.8% vs. 0.0%, P=0.039). Smokers and nonsmokers showed comparable changes in functional recovery according to Japanese Orthopedic Association scores (3.2±2.1 vs. 3.0±2.1, P=0.425) and in neck pain reduction using the Visual Analog Scale (-1.7±3.1 vs. -1.4±2.8, P=0.417) at the final follow-up.Conclusions:Smokers exhibited functional restoration and neck pain reduction after cervical posterior decompression. Attention is required, however, for the postoperative complication of delirium, which could be caused by the acute cessation of tobacco smoking after admission.Level of Evidence:Level III.
AB - Study Design:This was a case-control study.Objective:The objective of this study was to clarify the surgical outcomes after cervical posterior decompression in patients who smoked.Summary of Background Data:Smoking is associated with poor outcomes in the field of spinal surgery. However, the impact of tobacco smoking on the outcomes after posterior decompression surgery has not been fully evaluated in patients with cervical spondylotic myelopathy.Materials and Methods:In this retrospective multicenter study, 587 patients with cervical spondylotic myelopathy were enrolled at 17 institutions in Japan. Patients underwent cervical laminoplasty or laminectomy and were followed up for at least 1 year after surgery. Outcome measures were: preoperative smoking status, perioperative complications, the Japanese Orthopedic Association scale, and the Visual Analog Scale for neck pain. After adjusting for age and sex by exact matching, smoking and nonsmoking groups were compared using an unpaired t test for continuous variables or a χ2test for categorical variables.Results:There were 182 (31%) current smokers and 405 (69%) nonsmokers including previous smokers. After matching, 158 patients were extracted from each group. Demographic data and surgical information were almost the same between the groups. Regarding postoperative complications, there was no significant difference in the rate of surgical site infection, cerebrospinal fluid leakage, hematoma, segmental motor paralysis, or neurological deficit. However, smokers showed a significantly higher risk for delirium (3.8% vs. 0.0%, P=0.039). Smokers and nonsmokers showed comparable changes in functional recovery according to Japanese Orthopedic Association scores (3.2±2.1 vs. 3.0±2.1, P=0.425) and in neck pain reduction using the Visual Analog Scale (-1.7±3.1 vs. -1.4±2.8, P=0.417) at the final follow-up.Conclusions:Smokers exhibited functional restoration and neck pain reduction after cervical posterior decompression. Attention is required, however, for the postoperative complication of delirium, which could be caused by the acute cessation of tobacco smoking after admission.Level of Evidence:Level III.
KW - abstinence duration
KW - cervical spondylotic myelopathy
KW - exact matching
KW - nicotine cessation
KW - perioperative complications
KW - posterior decompression surgery
KW - postoperative delirium
KW - radiographic findings
KW - surgical outcomes
KW - tobacco smoking
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U2 - 10.1097/BSD.0000000000000984
DO - 10.1097/BSD.0000000000000984
M3 - Article
C2 - 33000929
AN - SCOPUS:85083564185
SN - 2380-0186
VL - 33
SP - E493-E498
JO - Clinical Spine Surgery
JF - Clinical Spine Surgery
IS - 10
ER -