Impact of Tobacco Smoking on Outcomes After Posterior Decompression Surgery in Patients With Cervical Spondylotic Myelopathy: A Retrospective Multicenter Study.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
2
10
2020
medline:
26
10
2021
entrez:
1
10
2020
Statut:
ppublish
Résumé
This was a case-control study. The objective of this study was to clarify the surgical outcomes after cervical posterior decompression in patients who smoked. 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. 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 χ test for categorical variables. 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. 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 III.
Sections du résumé
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 χ test 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.
Identifiants
pubmed: 33000929
doi: 10.1097/BSD.0000000000000984
pii: 01933606-202012000-00015
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E493-E498Références
Fehlings MG, Ibrahim A, Tetreault L, et al. A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine International study on 479 patients. Spine. 2015;40:1322–1328.
Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine. 1981;6:354–364.
Seichi A, Takeshita K, Ohishi I, et al. Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine. 2001;26:479–487.
Shiraishi T, Kato M, Yato Y, et al. New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application. Spine. 2012;37:E286–E296.
Nakashima H, Tetreault LA, Nagoshi N, et al. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients. J Neurol Neurosurg Psychiatry. 2016;87:734–740.
Isogai N, Nagoshi N, Iwanami A, et al. Surgical treatment of cervical spondylotic myelopathy in the elderly: outcomes in patients aged 80 years or older. Spine. 2018;43:E1430–E1436.
Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;362:847–852.
Berman D, Oren JH, Bendo J, et al. The effect of smoking on spinal fusion. Int J Spine Surg. 2017;11:29.
Jackson KL II, Devine JG. The effects of smoking and smoking cessation on spine surgery: a systematic review of the literature. Glob Spine J. 2016;6:695–701.
Khullar D, Maa J. The impact of smoking on surgical outcomes. J Am Coll Surg. 2012;215:418–426.
Chen Z, Li X, Pan F, et al. A retrospective study: does cigarette smoking induce cervical disc degeneration? Int J Surg. 2018;53:269–273.
Grisdela P Jr, Buser Z, D’Oro A, et al. Trends analysis of surgical procedures for cervical degenerative disc disease and myelopathy in patients with tobacco use disorder. Eur Spine J. 2017;26:2386–2392.
Iwahashi M, Matsuzaki H, Tokuhashi Y, et al. Mechanism of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking. Spine. 2002;27:1396–1401.
Eubanks JD, Thorpe SW, Cheruvu VK, et al. Does smoking influence fusion rates in posterior cervical arthrodesis with lateral mass instrumentation? Clin Orthop Relat Res. 2011;469:696–701.
Hilibrand AS, Fye MA, Emery SE, et al. Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am. 2001;83-A:668–673.
Kusin DJ, Ahn UM, Ahn NU. The effect of smoking on spinal cord healing following surgical treatment of cervical myelopathy. Spine. 2015;40:1391–1396.
Kusin DJ, Li SQ, Ahn UM, et al. Does tobacco use attenuate benefits of early decompression in patients with cervical myelopathy? Spine. 2016;41:1565–1569.
Lau D, Chou D, Ziewacz JE, et al. The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy: clinical article. J Neurosurg Spine. 2014;21:547–558.
Tetreault LA, Kopjar B, Vaccaro A, et al. A clinical prediction model to determine outcomes in patients with cervical spondylotic myelopathy undergoing surgical treatment: data from the prospective, multi-center AOSpine North America study. J Bone Joint Surg Am. 2013;95:1659–1666.
Lee JC, Lee SH, Peters C, et al. Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: the influence of smoking, sex, and number of operated levels. Spine. 2015;40:E571–E577.
Elmasry S, Asfour S, de Rivero Vaccari JP, et al. Effects of tobacco smoking on the degeneration of the intervertebral disc: a finite element study. PLoS One. 2015;10:e0136137.
Luszczyk M, Smith JS, Fischgrund JS, et al. Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation? Clinical article. J Neurosurg Spine. 2013;19:527–531.
Purvis TE, Rodriguez HJ, Ahmed AK, et al. Impact of smoking on postoperative complications after anterior cervical discectomy and fusion. J Clin Neurosci. 2017;38:106–110.
Kim HJ, Moon SH, Kim HS, et al. Diabetes and smoking as prognostic factors after cervical laminoplasty. J Bone Joint Surg Br. 2008;90:1468–1472.
Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine. 2006;31:2998–3005.
Nagoshi N, Tsuji O, Okada E, et al. Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Spinal Cord. 2019;57:644–651.
Nori S, Shiraishi T, Aoyama R, et al. Extremely high preoperative C7 slope limits compensatory cervical lordosis after muscle-preserving selective laminectomy. Eur Spine J. 2018;27:2029–2037.
Mouchoux C, Rippert P, Duclos A, et al. Impact of a multifaceted program to prevent postoperative delirium in the elderly: the CONFUCIUS stepped wedge protocol. BMC Geriatr. 2011;11:25.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–922.
Rockwood K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol. 1993;48:M162–M166.
Rockwood K, Cosway S, Carver D, et al. The risk of dementia and death after delirium. Age Ageing. 1999;28:551–556.
Gao R, Yang ZZ, Li M, et al. Probable risk factors for postoperative delirium in patients undergoing spinal surgery. Eur Spine J. 2008;17:1531–1537.
Imagama S, Kawakami N, Tsuji T, et al. Perioperative complications and adverse events after lumbar spinal surgery: evaluation of 1012 operations at a single center. J Orthop Sci. 2011;16:510–515.
Ushida T, Yokoyama T, Kishida Y, et al. Incidence and risk factors of postoperative delirium in cervical spine surgery. Spine. 2009;34:2500–2504.
Makiguchi T, Yokoo S, Kurihara J. Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer. Int J Oral Maxillofac Surg. 2018;47:998–1002.
Montes DM. Postoperative delirium in head and neck cancer patients: a survey of oncologic oral and maxillofacial surgeon practices. J Oral Maxillofac Surg. 2014;72:2591–2600.
Santos FS, Velasco IT, Fraguas R Jr. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr. 2004;16:175–193.
Lim TS, Lee JS, Yoon JH, et al. Cigarette smoking is an independent risk factor for post-stroke delirium. BMC Neurol. 2017;17:56.
Sommese T, Patterson JC. Acute effects of cigarette smoking withdrawal: a review of the literature. Aviat Space Environ Med. 1995;66:164–167.
Park H, Kim KW, Yoon IY. Smoking cessation and the risk of hyperactive delirium in hospitalized patients: a retrospective study. Can J Psychiatry. 2016;61:643–651.
Vandrey RG, Budney AJ, Hughes JR, et al. A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend. 2008;92:48–54.
Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57–71.
Dani JA, Heinemann S. Molecular and cellular aspects of nicotine abuse. Neuron. 1996;16:905–908.
Hshieh TT, Fong TG, Marcantonio ER, et al. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci. 2008;63:764–772.
Fineberg SJ, Nandyala SV, Marquez-Lara A, et al. Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine. 2013;38:1790–1796.
Lee JK, Park YS. Delirium after spinal surgery in Korean population. Spine. 2010;35:1729–1732.
Kobayashi K, Imagama S, Ando K, et al. Risk factors for delirium after spine surgery in extremely elderly patients aged 80 years or older and review of the literature: Japan Association of Spine Surgeons with Ambition Multicenter Study. Glob Spine J. 2017;7:560–566.
Lee JJ, Patel R, Biermann JS, et al. The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am. 2013;95:850–859.
Lindstrom D, Sadr Azodi O, Wladis A, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248:739–745.
Moller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359:114–117.
Glassman SD, Anagnost SC, Parker A, et al. The effect of cigarette smoking and smoking cessation on spinal fusion. Spine. 2000;25:2608–2615.
Ng KT, Gillies M, Griffith DM. Effect of nicotine replacement therapy on mortality, delirium, and duration of therapy in critically ill smokers: a systematic review and meta-analysis. Anaesth Intensive Care. 2017;45:556–561.