The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2

Mohamed Macki, Sbaa Syeda, Kenan R. Rajjoub, Panagiotis Kerezoudis, Ali Bydon, Jean Paul Wolinsky, Timothy F Witham, Daniel Sciubba, Mohamad Bydon, Ziya Gokaslan

Research output: Contribution to journalArticle

Abstract

Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.

Original languageEnglish (US)
Pages (from-to)459-464
Number of pages6
JournalWorld Neurosurgery
Volume97
DOIs
StatePublished - Jan 1 2017

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Arthrodesis
Reoperation
Pseudarthrosis
Smoking
Logistic Models
Spinal Diseases
Spinal Fusion
Incidence
Inpatients
Length of Stay
Spine
Confidence Intervals
Population

Keywords

  • Adjacent segment disease
  • Bone morphogenetic protein
  • Instrumented fusion
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2. / Macki, Mohamed; Syeda, Sbaa; Rajjoub, Kenan R.; Kerezoudis, Panagiotis; Bydon, Ali; Wolinsky, Jean Paul; Witham, Timothy F; Sciubba, Daniel; Bydon, Mohamad; Gokaslan, Ziya.

In: World Neurosurgery, Vol. 97, 01.01.2017, p. 459-464.

Research output: Contribution to journalArticle

Macki, Mohamed ; Syeda, Sbaa ; Rajjoub, Kenan R. ; Kerezoudis, Panagiotis ; Bydon, Ali ; Wolinsky, Jean Paul ; Witham, Timothy F ; Sciubba, Daniel ; Bydon, Mohamad ; Gokaslan, Ziya. / The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2. In: World Neurosurgery. 2017 ; Vol. 97. pp. 459-464.
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abstract = "Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6{\%}) were nonsmokers and 28 (25.5{\%}) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32{\%} incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4{\%} incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95{\%} confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.",
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T1 - The Effect of Smoking Status on Successful Arthrodesis After Lumbar Instrumentation Supplemented with rhBMP-2

AU - Macki, Mohamed

AU - Syeda, Sbaa

AU - Rajjoub, Kenan R.

AU - Kerezoudis, Panagiotis

AU - Bydon, Ali

AU - Wolinsky, Jean Paul

AU - Witham, Timothy F

AU - Sciubba, Daniel

AU - Bydon, Mohamad

AU - Gokaslan, Ziya

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.

AB - Objective The primary objective of this study is to examine the effects smoking status on rhBMP-2 supplementation in spinal fusion constructs. Methods Patient records were reviewed retrospectively for a consecutive set of patients who underwent first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease. All operations included arthrodesis supplementation with rhBMP-2. All patients were followed for at least 2 years. The primary endpoint of this study was reoperation for pseudarthrosis, instrumentation failure, or adjacent segment disease. After a rigorous sensitivity analysis, the measure of association was calculated with a multivariable logistic regression controlling for smoking, age, and number of spinal levels fused. Results Of the 110 patients in the study population, 82 (74.6%) were nonsmokers and 28 (25.5%) were smokers. Among perioperative predictors, smokers were younger in age (53.9 ± 9.6 vs. 61.1 ± 13.1 years; P = 0.008) and had shorter length of inpatient hospital stay (4.1 ± 1.8 vs. 5.3 ± 3.0; P = 0.039). After a mean follow-up of 59 months, the 32% incidence of reoperation for pseudarthrosis, instrumentation failure, or adjacent segment among smokers was statistically significantly higher than the 13.4% incidence in nonsmokers (P = 0.027). Following multivariable logistic regression, the odds of reoperation among smokers was 4.75-fold higher than for nonsmokers (P = 0.009; 95% confidence interval, 1.48–15.24). Conclusions While rhBMP-2 supplements arthrodesis of instrumented lumbar fusion constructs, smoking status ascertains the strongest predictor of reoperation for pseudarthrosis, instrumentation failure, and adjacent segment.

KW - Adjacent segment disease

KW - Bone morphogenetic protein

KW - Instrumented fusion

KW - Reoperation

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