Smoking Increases the Risk of Reoperation and an Extended Hospital Stay Following Anterior Cervical Discectomy With...

Retrospective cohort study.

To evaluate the influence of smoking on 30-day postoperative complications following anterior cervical discectomy with fusion (ACDF) surgery.

Although smoking can have significant negative effects on bone healing in orthopaedic surgery, there is currently conflicting literature regarding the effect of smoking on patients undergoing ACDF surgery.

Patients who underwent an ACDF procedure between 2011 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database by CPT code 22551 from 2011 to 2021. The study population was divided into 2 groups: smokers and nonsmokers. Chi-square tests for categorical variables and t-tests for continuous variables were used to identify differences in perioperative variables between groups. Multivariable logistic regression analysis assessed smoking status effect on postoperative outcomes after adjusting for these factors.

A total of 85,758 patients who underwent ACDF surgery were identified, of whom 22,223 (25.9%) were smokers and 63,535 (74.1%) were non-smokers. Smokers were younger than the non-smoker cohort (51.84 vs. 56.74 years, p<0.001). Smokers had a significant odds ratio (OR) for extended length of hospital stay (OR: 1.240, 95% CI: 1.114-1.380, p<0.001) and reoperation (OR: 1.144, 95% CI: 1.007-1.298, p=0.038), following a multivariate logistic regression analysis.

Patients with a history of smoking within the past year were at an increased risk for reoperation and extended length of stay after ACDF. These findings can enhance informed consent for patients with a smoking history. Future studies should evaluate patient-reported outcomes and pseudoarthrosis rates to further elucidate the role of smoking in cervical spine surgery.