This article is more than 5 years old. Information may no longer be current.
Study showed 40% of patients remained nonsmokers at 1 year after spine fusion
Click Here to Manage Email Alerts
Patients who cease smoking before undergoing spine fusion surgery tend to have better postoperative outcomes, but the rate of recidivism was high in the first 3 months following the procedure, according to results of a recently published study.
Douglas C. Burton, MD, and colleagues found recidivism rates in patients with no cessation maintenance was upward of 60% at 3 months post-operatively.
“This study, while small in number and suffering from a high number of patients lost to follow-up, showed that at 1 year after surgery nearly 40% of patients remain nicotine free. This is equivalent to the recidivism rate among patients who were actively trying to quit smoking and receiving active treatment for such. I believe this study shows that as physicians, we have an ability to impact our patients’ health in ways beyond our subspecialty interest,” Burton told Spine Surgery Today.
Cessation aids can help
Burton and colleagues studied 42 patients with serum-confirmed nicotine cessation prior to spinal fusion procedures. Patients were followed-up at 6 weeks, 3 months, 6 months and 1 year postoperatively. Staff members administered questionnaires to patients about tobacco use, serum nicotine and cotinine tests. Patients underwent clinical examinations and radiographs at every follow-up.
One patient opted out of the study at 6 months, and one patient died from an unknown cause.
The study findings showed postoperative recidivism rates of 60% at 4 months, 61% at 6 months, and 68% at 1 year. Three patients reported using cessation aids following their surgery. One patient used bupropion hydrochloride at the 3-month visit. Another patient used varenicline at the 1-year visit. The third patient who used an aid had a negative test result at 3 months, reported using a nicotine inhaler at the 6-month visit and reported using a nicotine patch at the 1-year visit.
Smoking may impact outcomes
“The standard practice in our academic spine group is to not perform elective spine fusions on active cigarette smokers due to the numerous deleterious effects of nicotine exposure to the postoperative patient. Over the course of several years, it became apparent that while many returned to cigarettes, a significant number of patients remained nicotine-free,” Burton told Spine Surgery Today.
Burton and colleagues noted in their study that preoperative protocols can influence tobacco cessation in current smokers who undergo spine fusion surgery. Relapsed smokers were significantly older than nonsmokers, based on the results of the study, but the investigators found no correlation between smoking status 3 months after surgery and a patient’s gender, complications or primary vs. revision surgery. – by Robert Linnehan
- Reference:
- Carlson BB, et al. Orthopedics. 2016;doi:10.3928/01477447-20160301-03.
- For more information:
- Douglas C. Burton, MD, can be reached at Department of Orthopedic Surgery, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160; email: dburton@kumc.edu.
Disclosure: Burton reports he receives grants and personal fees from DePuy Spine.
Perspective
Back to Top
Christopher T. Martin, MD
Recommending smoking cessation for active smokers prior to elective orthopedic procedures has become a widespread practice. Nicotine induces peripheral vasoconstriction and local tissue hypoxia, which in turn leads to decreased angiogenesis and epithelialization. Collagen is the primary determinant of the tensile strength of a surgical wound, and both human and animal models have shown decreased subcutaneous collagen production in smokers. Thus, as would be expected, the rates of wound complications have been reported to be higher in active smokers across multiple surgical disciplines, including spine.
Nonetheless, it is not clear that recommending smoking cessation can decrease these risks. Smoking-cessation programs are time-consuming and expensive, and patient compliance is notoriously poor. In this prospective cohort study by Carlson and colleagues, the authors report a recidivism rate of 60% in a cohort of 40 patients with 3-month follow-up who quit smoking prior to elective spine surgery. The process of wound healing and spinal fusion is unlikely to be complete by 3 months, and thus patients who return to smoking so soon after surgery may not see any benefit from quitting in the first place. The authors did not find any difference in complication rates between patients who remained abstinent and those who returned to smoking, but their study was not adequately powered for those outcomes.
This paper serves to emphasize the difficulties in ensuring patient compliance with smoking-cessation programs. Nonetheless, surgeons should be encouraged by the fact that a substantial number of the patients in this study (40%) were able to quit smoking and stay abstinent for 3 months postoperatively. These patients likely did benefit and the physician-led discussion on the impact of smoking likely had a profound impact on the patients decision to quit. Thus, it is clear the preoperative consent process represents a unique opportunity to advocate for smoking cessation. Surgeons should continue to recommend smoking cessation prior to elective cases, in spite of the challenges.
Click Here to Manage Email Alerts