Perspective from Christopher T. Martin, MD
June 14, 2016
3 min read

Study showed 40% of patients remained nonsmokers at 1 year after spine fusion

Perspective from Christopher T. Martin, MD
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Patients who cease smoking before undergoing spine fusion surgery tend to have better postoperative outcomes, but the rate of recidivism was high in the first 3 months following the procedure, according to results of a recently published study.

Douglas C. Burton, MD, and colleagues found recidivism rates in patients with no cessation maintenance was upward of 60% at 3 months post-operatively.

“This study, while small in number and suffering from a high number of patients lost to follow-up, showed that at 1 year after surgery nearly 40% of patients remain nicotine free. This is equivalent to the recidivism rate among patients who were actively trying to quit smoking and receiving active treatment for such. I believe this study shows that as physicians, we have an ability to impact our patients’ health in ways beyond our subspecialty interest,” Burton told Spine Surgery Today.

Cessation aids can help

Burton and colleagues studied 42 patients with serum-confirmed nicotine cessation prior to spinal fusion procedures. Patients were followed-up at 6 weeks, 3 months, 6 months and 1 year postoperatively. Staff members administered questionnaires to patients about tobacco use, serum nicotine and cotinine tests. Patients underwent clinical examinations and radiographs at every follow-up.

One patient opted out of the study at 6 months, and one patient died from an unknown cause.

The study findings showed postoperative recidivism rates of 60% at 4 months, 61% at 6 months, and 68% at 1 year. Three patients reported using cessation aids following their surgery. One patient used bupropion hydrochloride at the 3-month visit. Another patient used varenicline at the 1-year visit. The third patient who used an aid had a negative test result at 3 months, reported using a nicotine inhaler at the 6-month visit and reported using a nicotine patch at the 1-year visit.

Smoking may impact outcomes

“The standard practice in our academic spine group is to not perform elective spine fusions on active cigarette smokers due to the numerous deleterious effects of nicotine exposure to the postoperative patient. Over the course of several years, it became apparent that while many returned to cigarettes, a significant number of patients remained nicotine-free,” Burton told Spine Surgery Today.

Burton and colleagues noted in their study that preoperative protocols can influence tobacco cessation in current smokers who undergo spine fusion surgery. Relapsed smokers were significantly older than nonsmokers, based on the results of the study, but the investigators found no correlation between smoking status 3 months after surgery and a patient’s gender, complications or primary vs. revision surgery. – by Robert Linnehan

Disclosure: Burton reports he receives grants and personal fees from DePuy Spine.