Does Smoking Status Influence Health-Related Quality of Life Outcome Measures in Patients Undergoing ACDF?

John J. Mangan, Dhruv K.C. Goyal, Srikanth N. Divi, Daniel R. Bowles, Kristen J. Nicholson, Victor E. Mujica, Thomas J. Lee, Rosalie V. DePaola, Austin Saline, Taolin Fang, Matthew S. Galetta, I. David Kaye, Mark F. Kurd, Barrett I. Woods, Kris E. Radcliff, Jeffery A. Rihn, D. Greg Anderson, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro*Gregory D. Schroeder

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Study design: Retrospective comparative study. Objective: Whereas smoking has been shown to affect the fusion rates for patients undergoing an anterior cervical discectomy and fusion (ACDF), the relationship between smoking and health-related quality of life outcome measurements after an ACDF is less clear. The purpose of this study was to evaluate whether smoking negatively affects patient outcomes after an ACDF for cervical degenerative pathology. Methods: Patients with tumor, trauma, infection, and previous cervical spine surgery and those with less than a year of follow-up were excluded. Smoking status was assessed by self-reported smoking history. Patient outcomes, including Neck Disability Index, Short Form 12 Mental Component Score, Short Form 12 Physical Component Score (PCS-12), Visual Analogue Scale (VAS) arm pain, VAS neck pain, and pseudarthrosis rates were evaluated. Outcomes were compared between smoking groups using multiple linear and logistic regression, controlling for age, sex, and body mass index (BMI), among other factors. A P value <.05 was considered significant. Results: A total of 264 patients were included, with a mean follow-up of 19.8 months, age of 53.1 years, and BMI of 29.6 kg/m2. There were 43 current, 69 former, and 152 nonsmokers in the cohort. At baseline, nonsmokers had higher PCS-12 scores than current smokers (P =.010), lower VAS neck pain than current (P =.035) and former (P =.014) smokers, as well as lower VAS arm pain than former smokers (P =.006). Postoperatively, nonsmokers had higher PCS-12 scores than both current (P =.030) and former smokers (P =.035). Smoking status was not a significant predictor of change in patient outcome in multivariate analysis. Conclusions: Whereas nonsmokers had higher function and lower pain than former or current smokers preoperatively, smoking status overall was not found to be an independent predictor of outcome scores after ACDF. This supports the notion that smoking status alone should not deter patients from undergoing ACDF for cervical degenerative pathology.

Original languageEnglish (US)
Pages (from-to)50-56
Number of pages7
JournalGlobal Spine Journal
Issue number1
StatePublished - Jan 2021


  • Short Form-12 health survey
  • Visual Analogue Score
  • anterior cervical discectomy and fusion
  • arm pain
  • neck disability index
  • neck pain
  • patient reported outcome measurements
  • smoking

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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