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Smoking Is Associated With Longer Intensive Care Unit Stays in Spine Trauma Patients
Jerry Y Du1,2, Douglas S Weinberg1,2, Timothy A Moore1
1Department of Orthopaedic Surgery, MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, OH; and.
Objective:
To determine the impact of smoking on intensive care unit (ICU) outcomes in patients who underwent operative fixation for spine trauma.
Design:
Retrospective cohort study.
Setting:
Single academic level I trauma center.
Patients:
One hundred eighty-one consecutive surgical spine trauma patients from January 2010 to December 2014 requiring ICU stay.
Intervention:
Patients with smoking history compared to patients with no previous smoking history.
Main Outcome Measurements:
ICU length of stay, postoperative complications.
Results:
There were 297 spine trauma patients identified, of which 181 had an ICU stay (61%). There were 96 patients in the smoker cohort (53%) and 85 in the nonsmoker cohort (47%). On univariate analysis, the smoking cohort had a significantly longer ICU length of stay (11.0 ± 12.0 days vs. 8.01 ± 7.98 days, P = 0.046). Adjusting for confounders, smoking (beta: 3.99, P = 0.023), age ≥65 years (beta: 7.61, P = 0.001), body mass index ≥30 (beta: 4.47, P = 0.010), and American Spinal Injury Association Impairment Scale (beta: -1.39, P = 0.013) were independently associated with increased ICU length of stay. Smoking was not significantly associated with pneumonia (P = 0.238) or adult respiratory distress syndrome (P = 0.387) on multivariate analysis.
Conclusions:
A history of smoking, older age, obesity, and increasing American Spinal Injury Association Impairment Scale was independently associated with increased ICU length of stay in patients with surgical spine trauma. This study highlights the health care burden of smoking in the trauma population and may help physicians triage scarce ICU resources.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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