Smoking, Smoking Cessation, and Wound Complications After Lumbar Spine Surgery

Introduction: Smoking leads to increased incidence of wound complications after lumbar spine surgery. The paraspinal muscles are perfused by perforating arteries, and smoking may cause diminished vascularity and poor wound healing. This study was performed to determine the extent to which smoking cessation will decrease the risk of developing wound problems after lumbar spine surgery.

Materials and Methods: 1225 patients who had undergone lumbar surgery between 1997 and 2000 were retrospectively studied. Medical records and questionnaires were utilized to determine information on smoking history and cessation prior to surgery. Information was also collected on age, sex, BMI, levels exposed, whether or not fusion was performed, and whether or not the surgery was a revision. The outcome measure was the presence of a wound complication which included: wound infection (deep or superficial; N=7), seroma or hematoma formation (N=6), breakdown requiring wound care (N=9), and persistent drainage (greater than 7 days) requiring administration of oral antibiotics (N=21). A stepwise logistic regression analysis was performed to determine the effect of smoking and smoking cessation on wound complications.

Results: Positive smoking history was a risk factor for wound infection (OR=1.47, p=0.04). The risk increased for patients who smoked 2 or more packs per day (OR=2.95, p=0.03). Patients who had ceased smoking for at least 3 months were not at significantly higher risk for wound complications than nonsmokers (OR=1.12, p>0.05).

Conclusion: Wound complications after lumbar spine surgery are more common in smokers than in nonsmokers. Patients who smoke 2 or more packs per day are at nearly three times the risk of developing a wound complication. Smoking cessation 3 months or more prior to surgery may reduce the risk of wound complication and patients who are smokers should be encouraged to quit prior to surgery.