Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2022 Jun;162:e319-e327. doi: 10.1016/j.wneu.2022.03.003. Epub 2022 Mar 5.
The purpose of this retrospective cohort study was to investigate the impact of smoking on patient-reported outcome measures (PROMs) following elective posterior cervical decompression and fusion (PCF).
Electronic medical records at a single institution were reviewed for patients undergoing elective PCF. Patients were grouped based on smoking history: current smokers, former smokers, and never smokers. A delta score (Δ) was calculated for all PROMs (postoperative minus preoperative scores). Continuous and categorical data were compared using analysis of variance or χ tests. Regression analysis controlled for demographics. Patients were then regrouped into current smokers and nonsmokers for reanalysis.
A total of 195 patients were included, of whom 35 (22.1%) were current smokers, 51 (26.2%) were former smokers, and 101 (51.8%) were never smokers. Preoperative and postoperative Short-Form 12 Mental Component Score (MCS-12) were significantly lower in the current smoker group (preoperative: current 42.7, former 49.9, and never 46.6; P = 0.024; postoperative: current 44.6, former 53.7, and never 52.2; P = 0.003). Only never smokers improved in MCS-12 and Neck Disability Index following surgery. On regrouping, current smokers had significantly lower preoperative MCS-12 (42.7 vs. 47.7, P = 0.031), lower preoperative modified Japanese Orthopaedic Association (12.2 vs. 14.0, P = 0.039), greater preoperative visual analog scale Arm (6.39 vs. 4.94, P = 0.025), and lower postoperative MCS-12 (44.6 vs. 52.7, P = 0.001). Only the nonsmokers improved in MCS-12 and Neck Disability Index following surgery. On regression analysis, smoking was not an independent predictor of ΔPROMs.
Univariate analysis found that smokers have worse symptoms at baseline. However, smoking status was not an independent predictor of improvement in ΔPROMs following elective PCF.
本回顾性队列研究旨在探讨吸烟对择期颈椎后路减压融合术（PCF）后患者报告结局测量（PROM）的影响。
对一家单机构的电子病历进行回顾，纳入接受择期 PCF 的患者。根据吸烟史将患者分为以下三组：当前吸烟者、曾经吸烟者和从不吸烟者。计算所有 PROM（术后减去术前评分）的差值（Δ）。使用方差分析或 χ 检验比较连续和分类数据。回归分析控制了人口统计学因素。然后，将患者重新分为当前吸烟者和非吸烟者进行再分析。
共纳入 195 例患者，其中 35 例（22.1%）为当前吸烟者，51 例（26.2%）为曾经吸烟者，101 例（51.8%）为从不吸烟者。当前吸烟者组术前和术后简明健康调查量表 12 项精神健康评分（MCS-12）明显较低（术前：当前 42.7，曾经 49.9，从不 46.6；P=0.024；术后：当前 44.6，曾经 53.7，从不 52.2；P=0.003）。只有从不吸烟者在手术后 MCS-12 和颈椎残障指数（NDI）方面有改善。重新分组后，当前吸烟者的术前 MCS-12 明显较低（42.7 与 47.7，P=0.031），术前改良日本矫形协会评分（12.2 与 14.0，P=0.039）更低，术前视觉模拟量表上肢评分（6.39 与 4.94，P=0.025）更高，术后 MCS-12 更低（44.6 与 52.7，P=0.001）。只有非吸烟者在手术后 MCS-12 和 NDI 方面有改善。回归分析显示，吸烟不是 PROM 改善的独立预测因素。
单因素分析发现，吸烟者基线症状更严重。然而，吸烟状态不是择期 PCF 后 PROM 改善的独立预测因素。
