التفاصيل البيبلوغرافية
| العنوان: |
Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database. |
| المؤلفون: |
Asher AL; 1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina., Devin CJ; 2Departments of Orthopaedic Surgery and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, Tennessee., McCutcheon B; 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota., Chotai S; 2Departments of Orthopaedic Surgery and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, Tennessee., Archer KR; Departments of4Orthopaedic Surgery, Vanderbilt Spine Center.; 5Physical Medicine and Rehabilitation, and., Nian H; 6Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Harrell FE; 6Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., McGirt M; 1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina., Mummaneni PV; 7Department of Neurological Surgery, University of California, San Francisco, California., Shaffrey CI; 8Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia., Foley K; 9Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee; and., Glassman SD; 10Department of Orthopedic Surgery, University of Louisville, and the Norton Leatherman Spine Center, Louisville, Kentucky., Bydon M; 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota. |
| المصدر: |
Journal of neurosurgery. Spine [J Neurosurg Spine] 2017 Dec; Vol. 27 (6), pp. 661-669. Date of Electronic Publication: 2017 Sep 29. |
| نوع المنشور: |
Journal Article |
| اللغة: |
English |
| بيانات الدورية: |
Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 101223545 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1547-5646 (Electronic) Linking ISSN: 15475646 NLM ISO Abbreviation: J Neurosurg Spine Subsets: MEDLINE |
| أسماء مطبوعة: |
Original Publication: Charlottesville, VA : American Association of Neurological Surgeons, c2004- |
| مواضيع طبية MeSH: |
Databases, Factual* , Smokers*, Lumbar Vertebrae/*surgery , Lumbosacral Region/*surgery, Aged ; Back Pain/surgery ; Female ; Humans ; Intervertebral Disc Degeneration/surgery ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Retrospective Studies ; Treatment Outcome |
| مستخلص: |
OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration. METHODS A total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present. RESULTS In total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients' smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients' propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers. CONCLUSIONS Using a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers. |
| فهرسة مساهمة: |
Keywords: ASA = American Society of Anesthesiologists; BMI = body mass index; BP = back pain; CAD = coronary artery disease; LP = leg pain; NRS = numeric rating scale; ODI = Oswestry Disability Index; OR = odds ratio; PRO = patient-reported outcome; QOD; QOD = Quality Outcomes Database; lumbar; patient-reported outcomes; smoking; surgery |
| تواريخ الأحداث: |
Date Created: 20170930 Date Completed: 20180102 Latest Revision: 20190104 |
| رمز التحديث: |
20231215 |
| DOI: |
10.3171/2017.4.SPINE16984 |
| PMID: |
28960162 |
| قاعدة البيانات: |
MEDLINE |
