The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Lau, Darryl; Chou, Dean; Ziewacz, John E.; Mummaneni, Praveen V.

doi:10.3171/2014.6.spine13762

Cited by 84 publications

(95 citation statements)

References 33 publications

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“…An "optimal" outcome was defined as a change in mJOA score greater than or equal to the MCID of this scale. For patients with severe myelopathy (mJOA score < 12), the MCID is 3 points; for those with moderate disease (mJOA score of [12][13][14], the MCID is 2 points; and for those with mild disease (mJOA score ≥ 15), the MCID is 1 point. A "suboptimal" outcome was classified as a change in mJOA score that was less than the MCID, no change in status, or functional deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…15,21,30 In clinical studies, smoking has been shown to be associated with poor wound and bone healing and increased rates of pseudarthrosis and nonunion. 10,14 Decreased recovery in smokers is therefore likely due to a combination of vascular changes, impaired bone remodeling, and increased risk of complications. Future research is required to evaluate whether smoking cessation improves outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Patients presented with a wide array of neurological signs and symptoms, including hyperreflexia (77.90%), corticospinal distribution motor deficits (62.80%), numb hands (89.49%), weakness (82.88%), and gait impairment (76.55%). The average baseline mJOA score was 12.52 ± 2.74 (range 3-17 points), with 193 presenting with mild myelopathy (mJOA score of 15-17), 296 with moderate disease (mJOA score of [12][13][14], and 254 with severe disease (mJOA score < 12). Four hundred fifty-nine patients (61.78%) suffered from comorbidities, with the most common being cardiovascular (44.95%), endocrine (18.17%), and gastrointestinal (16.15%) disorders.…”

Section: Patientsmentioning

confidence: 99%

“…3,19,20 Based on two recent prospective studies, patients, on average, exhibited a 2.40-to 2.88-point gain on the modified Japanese Orthopaedic Association (mJOA) scale following surgery, an improvement exceeding the overall MCID for this metric (2 points). 2,5,8,28 The MCID of the mJOA scale, however, varies based on preoperative myelopathy severity: 1 point for mild myelopathy (mJOA ≥ 15), 2 points for moderate myelopathy (mJOA score of [12][13][14], and 3 points for severe disease (mJOA score < 12). 28 Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements in functional status.…”

mentioning

confidence: 99%

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Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Tetreault

Wilson

Kotter

et al. 2016

FOC

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OBJECTIVE The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial. Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements. The objective of this study was to define significant predictors of achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale at 2 years following surgery for the treatment of degenerative cervical myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively enrolled in either the AOSpine North America or International study at 26 global sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were excluded from this analysis (n = 743). Data were collected for each participating subject, including demographic information, symptomatology, medical history, causative pathology, and functional impairment. Univariate log-binominal regression analyses were conducted to evaluate the association between preoperative clinical factors and achieving an MCID on the mJOA scale. Modified Poisson regression using robust error variances was used to create the final multivariate model and compute the relative risk for each predictor. RESULTS The sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age of 56.48 ± 11.85 years. At 2 years following surgery, patients exhibited a mean change in functional status of 2.71 ± 2.89 points on the mJOA scale. Of the 687 patients with available follow-up data, 481 (70.01%) exhibited meaningful gains on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on univariate analysis, significant predictors of achieving the MCID on the mJOA scale were younger age; female sex; shorter duration of symptoms; nonsmoking status; a lower comorbidity score and absence of cardiovascular disease; and absence of upgoing plantar responses, lower-limb spasticity, and broad-based unstable gait. The final model included age (relative risk [RR] 0.924, p < 0.0001), smoking status (RR 0.837, p = 0.0043), broad-based unstable gait (RR 0.869, p = 0.0036), and duration of symptoms (RR 0.943, p = 0.0003). CONCLUSIONS In this large multinational prospective cohort, 70% of patients treated surgically for DCM exhibited a meaningful functional gain on the mJOA scale. The key predictors of achieving an MCID on the mJOA scale were younger age, shorter duration of symptoms, nonsmoking status, and lack of significant gait impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

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Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Tetreault

Wilson

Kotter

et al. 2016

FOC

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“…Owing to the welldocumented negative effects smoking has on many normal physiologic functions of the human body, we sought to determine whether patients with a smoking history were at an increased risk of blood loss and blood transfusions after undergoing lumbar spinal surgery compared with patients who did not smoke. Little research has evaluated the association between smoking and blood loss during spinal surgery [27]. The most-definitive available research in the area of orthopaedics has been performed in the setting of total joint arthroplasty [18].…”

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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Are perioperative allogeneic blood transfusions associated with 90‐days infection after operative treatment for bone metastases?

Pereira

Langerhuizen

Janssen

et al. 2016

Journal of Surgical Oncology

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The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Cited by 84 publications

References 33 publications

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Are perioperative allogeneic blood transfusions associated with 90‐days infection after operative treatment for bone metastases?

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