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Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? - A multicenter observational registry-based study
Charalampis Giannadakis MD1,2, Sasha Gulati MD PhD1,2, Trond Nordseth MD PhD3, Ulf S. Nerland MD1,2, Michel Gulati MD4, Clemens Weber MD2,5, Øystein P. Nygaard MD PhD1,2, Tore K. Solberg MD PhD6,7, Ole Solheim MD PhD1,2, Asgeir S. Jakola MD PhD1,8
Charalampis Giannadakis MD
Department of Neurosurgery, St. Olavs University Hospital, Trondheim, NO-7009, Trondheim, Norway
RESULTS
INTRODUCTION
Figure 1. Study enrollment and follow-up.
Table 1. Demographic characteristics, coexisting illnesses, and measures of health status for both groups (n=885).
A total of 825 patients were included (619 nonsmokers and 206 smokers). For the whole patient population there was a significant difference between preoperative ODI and ODI at 1 year (17.3 points, 95 % CI 15.93–18.67, p<0.001). There was a significant difference in ODI change at 1 year between nonsmokers and smokers (4.2 points, 95 % CI 0.98–7.34, p= 0.010). At 1 year 69.6 % of nonsmokers had achieved a minimal clinically important difference (≥10 points ODI improvement) compared to 60.8 % of smokers (p=0.008). There was no difference between nonsmokers and smokers in the overall complication rate (11.6 % vs %, p=0.34). There was no difference between nonsmokers and smokers in length of hospital stays for either single-level (2.3 vs. 2.2 days, p=0.99) or two-level (3.1 vs. 2.3 days, p=0.175) microdecompression. Smoking was identified as a negative predictor for ODI change in a multiple regression analysis (p=0.001). .
There are limited scientific data on the impact of smoking on patient-reported outcomes following minimally invasive spine surgery.
Variable
Non-smokers (n=619)
Smokers (n=206)
P-value
Age – yr
67.64
62.90
<0.001
Attended college – no. (%)
193 (31.2)
39 (18.9)
0.001
Body Mass Index
27.55
26.57
0.014
Deformity (spondylolisthesis and/or scoliosis)
77 (12.4)
23 (11.2)
0.627
Previous lumbar spine surgery
115 (18.8)
32 (15.8)
0.349
ASA grade >2
120 (19.8)
50 (25.4)
0.098
Preoperative ODI
38.99
42.27
0.005
AIM
The aim of this multicenter observational study was to examine the relationship between daily smoking and patient-reported outcome at 1 year using the Oswestry Disability Index (ODI) after microdecompression for single- and two-level central lumbar spinal stenosis (LSS). Secondary outcomes were the length of hospital stays, perioperative and postoperative complications.
Table 2. Surgical treatments, complications, and events.
Table 3. Multiple regression analysis. Difference in ODI 12 months after surgery.
Variable
Non-smokers (n=546)
Smokers (n=279)
P-value
Levels decompressed – no. (%)
- Single
402 (64.9)
217 (35.1)
0.192
- Two
144 (69.9)
62 (30.1)
Operation time (minutes)
- Single-level decompression
83.81
84.50
0.903
- Two-level decompression
118.65
108.18
0.090
Days in hospital no.
2.32
2.23
0.992
3.09
2.27
0.175
Any complication no. (%)
72 (11.6)
19 (9.2)
0.339
Perioperative complications no. (%)
24 (3.9)
7 (3.4)
0.754
- Dural tear or spinal fluid leak
21 (3.4)
6 (2.9)
0.737
- Blood replacement or postoperative hematoma
2 (0.3)
1 (0.5)
- Cardiovascular complications
1 (0.2)
0 (0)
0.564
- Anaphylactic reaction
- Wrong level surgery
Complications within 3 months no. (%)
50 (8.1)
12 (5.8)
0.288
- Wound infection
20 (3.2)
8 (3.9)
0.654
- Urinary tract infection
- Pneumonia
4 (0.6)
2 (1.0)
0.635
- Pulmonary embolism
MATERIALS & METHODS
Variable
Parameter estimate
95%
Confidence Interval
P-value
+Oswestry score 21-40, pre- surgery
10.5
<0.0001
+Oswestry score 41-60, pre- surgery
16.5
+Oswestry score > 60, pre-surgery
33.1
Smoker
–5.3
– –2.10
0.001
Age (per 10 year)
–0.9 –
0.237
Female sex
2.3 –
0.091
Attended college
3.0
0.048
Previous lumbar spine surgery
–8.3
– –4.89
*Body Mass Index 25 – 29.9 kg/m2
–0.6 –
0.697
*Body Mass Index 30 – 34.9 kg/m2
–4.6
– –0.62
0.024
*Body Mass Index >= 35 kg/m2
–13.2
– –6.40
<0.001
Data were collected through the Norwegian Registry for Spine Surgery (NORspine).
SUMMARY / CONCLUSION
AUTHOR AFFILIATIONS
Nonsmokers experienced a significantly larger improvement at 1 year following microdecompression for LSS compared to smokers. Smokers were less likely to achieve a minimal clinically important difference. However, it should be emphasized that considerable improvement also was found among smokers.
Dept. of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
Dept. of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
Dept. of Anesthesia, St. Olavs University Hospital, Trondheim, Norway
Dept. of General Surgery, Ålesund University Hospital, Ålesund, Norway
Dept. of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
Dept. of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
Dept. of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
ACKNOWLEDGEMENTS
The authors would like to thank the Norwegian Registry for Spine Surgery (NORspine). The NORspine registry receives funding from the University of Northern Norway and Norwegian health authorities.