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Influence of smoking on patient-reported outcome measures (PROMs) in patients undergoing surgery for adult spinal deformity: a propensity score‐matched analysis

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Abstract

Purpose

The purpose of this study was to determine the isolated influence of smoking in patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) surgery excluding known tobacco-related complications.

Methods

Retrospective analysis of a prospective multicenter ASD database. Patients operated on ASD with 2 year post-operative follow-up were included. Former smokers (non-active smokers) and patients developing mechanical or infectious complications were excluded. Changes of PROMs over time were analyzed using mixed models for repeated measures (MMRM). Propensity score matching (PSM) (1:1 ratio, caliper 0.10) was performed without replacement using optimum algorithm, tolerance ≤ 0.001, and estimated with 95% confidence interval (CI). PROMS in both groups were compared by paired t test or Wilcoxon signed-rank test.

Results

692 out of 1246 surgical patients met our inclusion criteria. 153 smokers were matched with 153 non-smokers according to age, BMI, number of fused levels, and global tilt. After PSM both groups were homogeneous regarding baseline parameters, surgical data, and complications (mechanical complications and infection excluded). Smokers had worse baseline results for SRS-total, SRS-pain COMI-back, and ODI; smokers also showed worse 2-year outcomes for SRS-total, SRS-function, SRS-pain, SRS-self-image, and ODI. However, no differences between the two groups were found in the improvement from baseline to 2-year follow-up or in the timing of this improvement (MMRM). The proportion of patients reaching the minimal clinically important difference (MCID) after surgery was similar in the two groups, but the proportion of patients reaching patient acceptable symptom state (PASS) was significantly lower in smokers for SRS-Subtotal, SRS-function, and SRS-image.

Conclusion

Even in the absence of smoking-related complications, smokers had worse PROMs at baseline and 2 years after surgery with less patients achieving PASS, but similar degrees on improvement compared to non-smokers. The proportion achieving MCID was also similar between the two cohorts.

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Acknowledgements

The authors would like to express their gratitude to Alfonso Muriel, biostatistician, for his help in statistical analysis of this study.

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No fundings were received for this study.

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Authors and Affiliations

  1. Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9, 100, 28034, Madrid, Spain

    Alejandro Gomez-Rice

  2. Vall d’Hebron Institut de Recerca, Barcelona, Spain

    María Capdevila-Bayo

  3. Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Susana Núñez-Pereira, Sleiman Haddad & Ferran Pellise

  4. Hospital Universitario La Paz, Madrid, Spain

    Franciso Pérez-Grueso & Javier Pizones

  5. Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück

  6. CHU Bordeaux, Bordeaux, France

    Ibrahim Obeid

  7. Acibadem Hospital, Istanbul, Turkey

    Ahmet Alanay

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Contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: AGR, MCB, SNP, SH, FPG, FK, IO, AA, FP, JP, and ESSG European Spine Study Group. Drafting the work or revising it critically for important intellectual content: AGR, MCB, SNP, SH, FPG, FK, IO, AA, FP, JP, and ESSG European Spine Study Group. Final approval of the version to be published: AGR, MCB, SNP, SH, FPG, FK, IO, AA, FP, JP, and ESSG European Spine Study Group. Accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: AGR, MCB, SNP, SH, FPG, FK, IO, AA, FP, JP, and ESSG European Spine Study Group.

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Correspondence to Alejandro Gomez-Rice.

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Gomez-Rice, A., Capdevila-Bayo, M., Núñez-Pereira, S. et al. Influence of smoking on patient-reported outcome measures (PROMs) in patients undergoing surgery for adult spinal deformity: a propensity score‐matched analysis. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00821-2

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