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Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database.

Publication ,  Journal Article
Asher, AL; Devin, CJ; McCutcheon, B; Chotai, S; Archer, KR; Nian, H; Harrell, FE; McGirt, M; Mummaneni, PV; Shaffrey, CI; Foley, K; Bydon, M ...
Published in: J Neurosurg Spine
December 2017

OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration. METHODS A total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present. RESULTS In total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients' smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients' propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers. CONCLUSIONS Using a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

December 2017

Volume

27

Issue

6

Start / End Page

661 / 669

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Smokers
  • Retrospective Studies
  • Orthopedics
  • Neurosurgical Procedures
  • Middle Aged
  • Male
  • Lumbosacral Region
  • Lumbar Vertebrae
  • Intervertebral Disc Degeneration
 

Citation

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Asher, A. L., Devin, C. J., McCutcheon, B., Chotai, S., Archer, K. R., Nian, H., … Bydon, M. (2017). Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database. J Neurosurg Spine, 27(6), 661–669. https://doi.org/10.3171/2017.4.SPINE16984
Asher, Anthony L., Clinton J. Devin, Brandon McCutcheon, Silky Chotai, Kristin R. Archer, Hui Nian, Frank E. Harrell, et al. “Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database.J Neurosurg Spine 27, no. 6 (December 2017): 661–69. https://doi.org/10.3171/2017.4.SPINE16984.
Asher AL, Devin CJ, McCutcheon B, Chotai S, Archer KR, Nian H, et al. Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2017 Dec;27(6):661–9.
Asher, Anthony L., et al. “Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database.J Neurosurg Spine, vol. 27, no. 6, Dec. 2017, pp. 661–69. Pubmed, doi:10.3171/2017.4.SPINE16984.
Asher AL, Devin CJ, McCutcheon B, Chotai S, Archer KR, Nian H, Harrell FE, McGirt M, Mummaneni PV, Shaffrey CI, Foley K, Glassman SD, Bydon M. Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2017 Dec;27(6):661–669.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

December 2017

Volume

27

Issue

6

Start / End Page

661 / 669

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Smokers
  • Retrospective Studies
  • Orthopedics
  • Neurosurgical Procedures
  • Middle Aged
  • Male
  • Lumbosacral Region
  • Lumbar Vertebrae
  • Intervertebral Disc Degeneration