• Raul A Vasquez-Castellanos, Silky Chotai, Joseph Wick, David P Stonko, Joseph S Cheng, Clinton J Devin, Anthony L Asher, and Matthew J McGirt.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:199-200.

IntroductionSmoking has been associated with worse self-reported outcomes in patients undergoing degenerative lumbar spine surgery. Current focus is on decreasing cost and complications while improving outcomes. This potentially can be accomplished by acting on modifiable preoperative patient characteristics such as smoking. However, the impact of smoking on outcomes following degenerative cervical spine surgery is poorly understood. The aim of the study is to understand impact of smoking on patient-reported outcomes after degenerative cervical spine surgery.MethodsA total of 473 patients enrolled in a prospective longitudinal registry undergoing cervical degeneration surgery over a period of 1 year were included in the study. Smoking status, demographics, and patient-reported outcomes were obtained. The patient-reported outcomes were obtained preoperatively, at 3 months and 1 year following surgery. The instruments utilized include: numeric neck and arm pain, NDI, SF-12, mJOAS (those with myelopathy), and EQ-5D. The patients were divided into smokers and nonsmokers to compare patient-reported outcomes.ResultsA total of 123 (26%) patients reported to be current smokers at the moment of the initial evaluation and 350 (74%) patients were not smoking. The smoking population was younger (51 vs 56 years old, P < .001), and had at higher preoperative use of narcotics than nonsmokers (56% vs 50%, P = .046). At baseline and 12-month follow-up, smokers had significantly higher arm and neck pain scores, NDI percentages, and lower EQ-5D scores. The smoking population had less improvement in neck pain, NDI percentages, mJOAS, and SF-12 PCS at 12-month follow-up. The smoking population reported lower satisfaction scores, with 24% of smokers having unfulfilled expectations at 12 months after surgery, vs 14% in the nonsmokers group (P < .013).ConclusionThe smoking population was younger and had a higher preoperative narcotic use. Smoking results in lower absolute scores and these patients have less benefit following surgical intervention compared with the nonsmokers, after controlling for confounding variables. Smoking cessation should be strongly considered before surgical intervention so as to optimize outcome.

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