P109. Tobacco use is associated with worse patient-reported outcomes following elective cervical spine surgery

Abstract

BACKGROUND CONTEXT Tobacco use has been shown to be a major modifiable risk factor for the development of postoperative complications in elective orthopedic surgeries. Numerous studies have described the adverse health effects of tobacco use and the associations between tobacco use and poor surgical outcomes, as well as increased post-operative health care utilization. PURPOSE The purpose of this study was to investigate the effect of preoperative tobacco use on (1) pre- and postoperative patient-reported outcomes, (2) complications, and (3) pre- and postoperative opioid consumption in patients undergoing elective cervical spine surgery. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE A total of 179 consecutive patients who underwent elective cervical spine surgery at a single academic institution from 2014-2016 with 2-year follow up data. OUTCOME MEASURES Perioperative variables, pre- and postoperative, opiod consumption, Neck Disabiity Index (NDI) score, VAS (visual analog scale) pain scores and Distressed Communities Index (DCI) METHODS Patient tobacco use, baseline characteristics, medical comorbidities, operative variables, and surgical complications (superficial and deep infection, wound complication, emergency department [ED] visits, readmissions, and repeat operations) were recorded. Additionally, preoperative ED visits, pre- and postoperative opioid use, total postoperative opioid prescription quantities, and most recent date of opioid prescription were collected. Quantitative measurements of pain (VAS) and disease specific disability score (NDI) were recorded preoperatively and 3 months after surgery. In addition, the Economic Innovation Group's 2017 Distressed Communities Index (DCI) was recorded for each patient's home zip code. DCI Scores are based on percentages of adults without a high school education, percentage living under the poverty line, unemployment rates, and the overall housing and business climate in a given area. DCI Scores range from 0 to 100, with higher scores indicative of greater economic distress, and DCI Scores ≥80 are considered to be highly distressed regions. Continuous variables were compared between patients that did vs did not use tobacco using two-tailed independent t-test, and categorical variables were compared using chi-square or Fisher Exact tests. RESULTS Of the 179 patients involved in this study, 98 (54.7%) were current tobacco users. Compared to non-users, current tobacco users were more likely to have COPD (p=0.001), illicit drug abuse (p=0.002), and worse distressed community index scores (p=0.02). Tobacco users had less pain relief than non-smokers at 3 months postoperatively (4.9±2.7 vs. 2.7±2.3, respectively), as they experienced significantly less improvement in VAS pain score (p 0.05). There were no other between-group differences. CONCLUSIONS Tobacco users undergoing elective cervical spine surgery may experience significantly worse pain during the early postoperative period compared to non-smokers. Tobacco use may represent a modifiable risk factor for persistent pain in this population. Surgeons should counsel patients about reducing tobacco use before cervical spine surgery, and socioeconomic status should be considered when developing patient education materials and smoking cessation programs for this at risk subset. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.