LAUSR

OBJECTIVE 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). METHODS 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 (ANOVA) or chi-square tests. Regression analysis controlled for demographics. Patients were then regrouped into current smokers and non-smokers for reanalysis. RESULTS A total of 195 patients were included, of which 35 (22.1%) were current smokers, 51 (26.2%) were former smokers, and 101 (51.8%) were never smokers. Preoperative and postoperative 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 NDI following surgery. On regrouping, current smokers had significantly lower preoperative MCS-12 (42.7 vs. 47.7, p=0.031), lower preoperative mJOA (12.2 vs. 14.0, p=0.039), higher preoperative VAS Arm (6.39 vs. 4.94, p=0.025), and lower postoperative MCS-12 (44.6 vs. 52.7, p=0.001). Only the non-smokers improved in MCS-12 and NDI following surgery. On regression analysis, smoking was not an independent predictor of ΔPROMs. CONCLUSIONS 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.