Smoking Is an Independent Risk Factor for 90-Day Readmission and Reoperation Following Posterior Cervical Decompression and Fusion

Abstract

BACKGROUND Posterior cervical decompression and fusion (PCF) is a common procedure used to treat various cervical spine pathologies, but the 90-d outcomes following PCF surgery continue to be incompletely defined. OBJECTIVE To identify risk factors associated with 90-d readmission and reoperation following PCF surgery. METHODS Adults undergoing PCF from 2012 to 2020 were identified. Demographic and radiographic data, surgical characteristics, and 90-d outcomes were collected. Univariate analysis was performed using Student's t-test, chi square, and Fisher exact tests as appropriate. Multivariable logistic regression models with lasso penalty were used to analyze various risk factors. RESULTS A total of 259 patients were included. The 90-d readmission and reoperation rates were 9.3% and 4.6%, respectively. The most common reason for readmission was surgical site infection (SSI) (33.3%) followed by new neurological deficits (16.7%). Patients who smoked tobacco had 3-fold greater odds of readmission compared to nonsmokers (odds ratio [OR]: 3.48; 95% CI 1.87-6.67; P = .0001). Likewise, the most common reason for reoperation was SSI (33.3%) followed by seroma and implant failure (25.0% each). Smoking was also an independent risk factor for reoperation, associated with nearly 4-fold greater odds of return to the operating room (OR: 3.53; 95% CI 1.53-8.57; P = .003). CONCLUSION Smoking is a significant predictor of 90-d readmission and reoperation in patients undergoing PCF surgery. Smoking cessation should be strongly considered preoperatively in elective PCF cases to minimize the risk of 90-d readmission and reoperation.

Impact of Smoking On Surgical Outcomes For Patients Undergoing Cervical Surgery: A Systematic Review And Meta-Analysis

“…Of these, 16 were cohort studies, and 27 were case-controls. Patients in twenty-eight studies underwent anterior cervical surgery 57 , eight underwent posterior cervical surgery 4,12,14,15,36,40,41,48 , and the remaining seven underwent anterior and posterior cervical surgery 2,7,13,21,35,42,50 .…”

“…The primary outcomes in our meta-analysis were complications, including dysphagia, airway obstruction, nerve palsy, reintubation, axial neck pain, wound infection, deep venous thrombosis, pneumonia, deltoid weakness, tracheobronchitis, and pseudarthrosis. At least one postoperative complication was reported in 20 studies 2,3,11,12,14,16,18,20,21,30,[34][35][36]39,41,43,44,48,52,53 . Signi cant heterogeneity was observed, and the random-effects model was used (I²=52%, p=0.003).…”

“…The number of patients who underwent reoperation was provided in eight studies 4,[11][12][13]20,42,47,50 . Signi cant heterogeneity was observed, and a randomeffects model was used (I²=58%, p=0.02).…”

“…Seven studies reported the postoperative incidence of wound infection 7,11,12,14,18,30,36 . No signi cant heterogeneity was observed, and a xed-effects model was used (I²=17%, p=0.30).…”

“…Some studies suggest that smoking may be associated with poorer outcomes after cervical surgery, including lower fusion rates 9,10 . Smoking has been independently linked to higher blood loss 11 , longer lengths of stay 2,11 , and higher reoperation rates 12,13 . There is also an increased risk of perioperative complications, including dysphagia, airway obstruction, nerve palsy, reintubation, axial neck pain, wound infection, deep venous thrombosis, pneumonia, and pseudarthrosis 7,11,12,14−17 .…”