How does smoking influence patient-reported outcomes in patients after lumbar fusion?

Dhruv K.C. Goyal*, Srikanth N. Divi, Daniel R. Bowles, Kristen J. Nicholson, Victor E. Mujica, 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

4 Scopus citations


Study Design:A retrospective cohort study.Objective:The goal of this study was to determine the effect of smoking on patient-reported outcome measurements (PROMs) after lumbar fusion surgery.Summary of Background Data:Although smoking is known to decrease fusion rates after lumbar fusion, there is less evidence regarding the influence of smoking on PROMs after surgery.Methods:Patients undergoing between 1 and 3 levels of lumbar fusion were divided into 3 groups on the basis of preoperative smoking status: never smokers (NS); current smokers (CS); and former smokers (FS). PROMs collected for analysis include the Physical Component Score (PCS-12), Mental Component Score (MCS-12), Oswestry Disability Index (ODI), and Visual Analogue Scale back (VAS back) and leg (VAS leg) pain scores. Preoperative and postoperative PROMs were compared between groups. A multiple linear regression analysis was performed to determine whether preoperative smoking status was a predictor of change in PROM scores.Results:A total of 220 (60.1%) NS, 52 (14.2%) CS, and 94 (25.7%) FS patients were included. Patients in most groups improved within each of the PROMs analyzed (P<0.05). VAS leg pain (P=0.001) was found to significantly differ between groups, with NS and FS having less disability than CS (3.6 vs. 2.0, P=0.010; and 3.6 vs. 2.4, P=0.022; respectively). Being a CS significantly predicted less improvement in ODI (P=0.035), VAS back (P=0.034), and VAS leg (P<0.001) compared with NS. In addition, NS had a significantly lower 30-day readmission rate than CS or FS (3.2% vs. 5.8% and 10.6%, respectively, P=0.029).Conclusion:CS exhibited worse postoperative VAS leg pain and a lower recovery ratio than never smokers. In addition, being in the CS group was a significant predictor of decreased improvement in ODI, VAS back, and VAS leg scores.Level of Evidence:Level III.

Original languageEnglish (US)
Pages (from-to)E45-E50
JournalClinical spine surgery
Issue number1
StatePublished - Feb 2021


  • Arthrodesis
  • Fusion
  • Lumbar
  • MCS-12
  • ODI
  • PCS-12
  • PROMs
  • Smoking
  • VAS back
  • VAS leg

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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