The London Spine Unit : most experienced treatment clinic in UK
CONCLUSIONS: Current smokers at the time of surgery have inferior postoperative EQ-5D scores, increased pain and disability, and lower odds of achieving the MCID at 1-year after undergoing LTMD when compared to patients without any smoking history.Lumbar Disc Replacement Expert. Best Spinal Surgeon UK
Background context: There has been a shift in the spine literature in reporting meaningful outcomes, including MCID, after surgery. The evidence on the effect of tobacco smoking at the time of LTMD on meaningful outcomes is limited.
Purpose: To compare differences in 1-year functional outcomes and rates of achieving meaningful clinically important difference (MCID) between current smokers and non-smokers who underwent lumbar tubular microdecompression (LTMD) for lumbar spinal stenosis (LSS).
Study design: A nested case control study to compare the difference in patient reported outcomes (PROs) between smokers and non-smokers 1-year after undergoing LTMD.
Patient sample: This study included patients that underwent single level LTMD by a single surgeon between January 2014 through August 2019.
Outcome measures: Preoperative and postoperative patient reported outcomes (PROs) were recorded using the questionnaires EQ-5D, Oswestry Disability Index (ODI), and the visual analog scale (VAS) for back pain and leg pain. The meaningful clinically important difference (MCID) was also used.
Methods: Current tobacco smokers at the time of surgery were matched 1:2 to non-smokers by age (+/- 1year). Preoperative and postoperative functional scores were compared between the two groups using independent t-tests. Additionally, thresholds for achieving MCID were calculated for each individual functional score, and were compared using Fisher’s exact test.
Results: Of the 183 patients with 1-year follow-up who met inclusion criteria, 35 patients were identified as smokers and were matched to 70 non-smokers. No statistical differences were identified between age, BMI, or gender. Comparison of preoperative PROs showed no statistically significant differences between smokers and non-smokers (p>0.05 for all), while smokers had statistically lower EQ-5D (p<0.001) and higher ODI (p=0.05), VAS back (p=0.033), and VAS leg (p=0.03) score averages at a minimum of one year follow-up. Evaluation of meaningful outcomes demonstrated non-smokers had higher rates of achieving MCID on at least 1 threshold score as compared to smokers (98.5% vs 91.1%; p=0.043).
Conclusions: Current smokers at the time of surgery have inferior postoperative EQ-5D scores, increased pain and disability, and lower odds of achieving the MCID at 1-year after undergoing LTMD when compared to patients without any smoking history.
Keywords: 1-year outcomes; MCID; Smoking; microdecompression.
The London Spine Unit : most experienced treatment clinic in UKRead more here:The Effect of Smoking on Achieving Meaningful Clinical Outcomes 1-Year After Lumbar Tubular Microdecompression: A Matched-Pair Cohort Analysis