BACKGROUND: Little is known about the association between smoking and intraoperative @entity190 and perioperative transfusion use in @entity1 undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical @entity1 had been well documented, the aspect of @entity190 seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. QUESTIONS/PURPOSES: We asked: (1) Is smoking associated with increased estimated @entity190 during surgery in @entity1 undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage? METHODS: Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize @entity1 by smoking status, necessary intra- and postoperative data to allow analysis with respect to @entity548 and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: @entity1 whose smoking status did not fit in our two categories, @entity1 with underlying @entity1003 , patients receiving anticoagulants (including @entity117 and platelet inhibitors), history of @entity99 , history of @entity1423 or other @entity1503 , and @entity1 or family history of any other known @entity3459 . Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the @entity1 reported smoking up until the day of their surgical procedure; nonsmokers were @entity1 who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether @entity1 did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all @entity1 regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of @entity1296 , @entity591 , decreased exertional tolerance, or @entity551 that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative @entity190 , while logistic regression was used to analyze perioperative transfusion use. RESULTS: After controlling for potentially relevant confounding variables noted earlier, we found smokers had increased estimated @entity190 compared with nonsmokers (mean, 328 mL more for each pack per day smoked; 95% CI, 249-407 mL; p < 0.001). We also found that again correcting for confounders, smokers had increased perioperative transfusion use compared with nonsmokers (odds ratio, 13.8; 95% CI, 4.59-42.52). CONCLUSIONS: Smoking is associated with increased estimated surgical @entity190 and transfusion use in @entity1 undergoing lumbar spine surgery. @entity1 who smoke should be counseled regarding these risks and on smoking cessation before undergoing lumbar surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.

Smoking is Associated with Increased XXXX and Transfusion Use After Lumbar Spinal Surgery.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity1423 :: ('MESH:D001791', 'Disease') :: ['platelet disorder'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity1003 :: ('MESH:D001778', 'Disease') :: ['coagulopathy'] @entity1503 :: ('MESH:D006402', 'Disease') :: ['blood dyscrasias'] @entity3459 :: ('MESH:D025861', 'Disease') :: ['bleeding disorder'] @entity591 :: ('MESH:D013610', 'Disease') :: ['tachycardia'] @entity551 :: ('MESH:D007022', 'Disease') :: ['hypotension'] @entity1296 :: ('MESH:D004244', 'Disease') :: ['dizziness'] @entity99 :: ('MESH:D056486', 'Disease') :: ['hepatic disease']
@entity190 :: (MESH:D006473,Disease) :: ['Blood Loss']
