435 Non-smokers and Smokers Undergoing Decompression for Lumbar Spinal Stenosis and Lumbar Disc Herniation Experience Similar Clinical Improvement at 12 Months

Abstract

INTRODUCTION: Smoking has been shown to be detrimental on patient reported outcomes (PROs) and fusion with lumbar arthrodesis. Evidence is unclear whether smoking affects PROs in patients undergoing decompression only. METHODS: Patients who underwent 1 or 2-level decompression only for LDH or LSS enrolled in QOD were identified. Demographics, surgical variables, smoking status and PROs at baseline and 12 months postoperatively were collected. RESULTS: 3038 Smokers and 14,233 Nonsmokers met inclusion criteria. Smokers were younger (50.3 vs 56.7, p<0.000), had worse ASA grades (2.3 vs 2.2, p<0.000) and had more males (1663, 55% vs 7130, 50%, p<0.000) compared to Nonsmokers. Number of surgical levels was similar between groups (1.7, p = 0.169). For all PROs, both Smokers and Nonsmokers improved following surgery. Preoperative PROs in Smokers were worse (p<0.000) for BP (7.0 vs 6.1), LP (7.4 vs 6.9), ODI (52.2 vs 45.9) and EQ-5D (0.5 vs 0.6). PRO improvement in Smokers was less than in Nonsmokers at 12-months (p<0.001), but may be clinically irrelevant: BP (3.2 vs 3.3), LP (4.3 vs 4.6), ODI (25.0 vs 26.8) and EQ-5D (0.24 vs 0.26). Only 60 LSS and 38 LDH cases could be propensity matched, with no significant differences in improvements in PROs in the LSS group (ΔBP:3.2 vs 3.5, p = 0.577; ΔLP:3.3 vs 4.5, p = 0.097; ΔODI:18.1 vs 23.5, p = 0.155; ΔEQ5D: 0.2 vs 0.2, p = 0.948) or in the LDH group (ΔBP:3.1 vs 3.7, p = 0.530; ΔLP:3.7 vs 5.3, p = 0.050; ΔODI:24.6 vs 28.6, p = 0.463; ΔEQ5D: 0.2 vs 0.3, p = 0.301). CONCLUSIONS: Although Nonsmokers demonstrated greater improvement in all PROs, these differences were small and less evident in a propensity-matched sub-analysis. Compared to fusion surgery, both smokers and non-smokers treated with decompression only for LDH or LSS exhibit significant clinical improvement in PROs.