경추체 제거술 후의 수술결과와 위관절증에 대한 흡연의 영향 The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Brief review

JNS에서 10월호에 출판된 재밌는 논문 입니다.

결론부터 말하자면, 경추체 제거술 후의 수술결과와 합병증(pseudarthrosis)에 흡연여부가 유의하게 영햐을 미친다는 내용 입니다.

흡연여부에 따라 피험자를 비흡연자/ 끊은지 최소 1년이상된 자/ 흡연자  의 3그룹으로 나누었고, 이 피험자들의 30일이내 합병증 발병, 출혈량, 재원일수 등의 항목을 조사하였습니다.

결과적으로 흡연여부는 더 높은 합병증 발병률, 더 긴 재원일수에 영향을 미치는 risk factor로 밝혀졌으며, 감염 및 pseudarthrosis등의 합병증 발병에 특히 영향을 미친다고 합니다.

흡연의 해로움을 객관적 데이터로 보여준 논문입니다.

*Title: The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy.

경추체 제거술 후의 수술결과와 위관절증에 대한 흡연의 영향

*Authors: Lau D, Chou D, Ziewacz JE, Mummaneni PV

*Bibliography: J Neurosurg Spine. 2014 Oct;21(4):547-58.

Object

Smoking is one of the leading causes of preventable morbidity and death in the US and has been associated with perioperative complications.

-To examined the effects of smoking on perioperative outcomes and pseudarthrosis rates following anterior cervical corpectomy.

Methods

▶Subjects: adult patients underwent anterior cervical corpectomy (2006~2011)

▶Grouping:

1) nonsmokers

2) quitters (quit for at least 1yr)

3) current smokers

▶Statistical analysis: using multivariate analysis

(To define the relationship between smoking and blood loss, 30-day complications, length of hospital stay, and pseudarthrosis)

Results

▶Total 160 patients were included in the study.

(nonsmokers 49.4%, quitters 25.6%, current smokers 25.0%)

▶30-day complication rate: 20.0% (pseudarthrosis: 7.6%)

▶Mean blood loss: 368.3ml

▶Mean length of stay: 6.5days.

-Current smoking status was significantly associated with higher complication rates (p < 0.001) and longer lengths of stay (p < 0.001).

-Current smoking status remained an independent risk factor for both outcomes.

                                     

The complications that were experienced in current smokers were mostly infections (76.5%).

(Significantly greater than in nonsmokers and quitters (p = 0.013))

-Current smoking status was also an independent risk factor for pseudarthrosis at 1-year follow-up (p = 0.012).

Conclusions

Smoking is independently associated with higher perioperative complications (especially infectious complications), longer lengths of stay, and higher rates of pseudarthrosis in patients undergoing anterior cervical corpectomy. 

Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

Brief review

이 논문은 단일분절에 전방경유 경추 절제 및 유합술(ACDF)를 시행한 환자들을 대상으로 흡연여부가 유합률에 영향을 주는가에 대해 연구한 내용 입니다.

단일 분절에 ACDF를 시행한 환자 573명(흡연자156명+비 흡연자417명)의 데이터를 분석하여 수술시점으로부터 2년이 지난 후, 방사선학적 측정을 통해 유합률을 조사하였습니다

.

결과적으로 본 연구의 대상이 된 흡연, 비 흡연 환자들 간의 유합률에는 통계적으로 유의한 차이가 없다고 합니다. (p=0.867)

*Title: Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

흡연이 동종골과 금속판 고정을 동반한 전방경유 경추 절제 및 유합술에서 유합률에 영향을 미치는가?

*Authors: Myles Luszczyk, Justin S. Smith, Jeffrey S. Fischgrund, Steven C. Ludwig, Rick C. Sasso, Christop her I. Shaffrey, Alexander R. Vaccaro

*Bibliography: J Neurosurg Spine. 2013 Nov;19(5):527-31.

Object

Effect of smoking on fusion rates of the cervical and lumbar spine

: -In multilevel fusions: shown to negatively affect. (in cervical and lumbar)

-In single-level anterior cervical discectomy and fusion(ACDF): has yet to investigated.

Purpose: To address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate.

Methods

▶Subject: patients underwent a 1-level ACDF with allograft and a locked cervical plate.

▶Subject number: 573 patients(156 smokers + 417 nonsmokers)

▶follow-up period: 24 months

▶Evaluation method: assessed radiographic evidence (lateral, neutral, and flexion/extension)

-The authors reviewed subject patients data.

Results

▶Overall fusion rate: 91.4% (all patients)

▶Solid fusion:

- nonsmokers: 382 patients (91.6%)

- smokers: 142 (91.0%)

-->No difference in the union rates between smokers and nonsmokers.(p=0.867)

Conclusions

Not significantly different in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate.