Evaluating 180-Day Outcomes in Smokeless and Traditional Tobacco Users Following Anterior Cervical Discectomy and Fusion: A Retrospective Analysis of a National Cohort.

STUDY

DESIGN

Population-based retrospective study.

OBJECTIVE

To compare the impact of cigarette smoking and smokeless tobacco use on postoperative outcomes after anterior cervical discectomy and fusion.

BACKGROUND

Cigarette smoking has been associated with negative postoperative outcomes after anterior cervical discectomy and fusion (ACDF). While cigarette use has declined, the use of smokeless tobacco has increased. Although several studies have investigated the effects of smokeless tobacco in orthopedic surgery, limited data exist for ACDF.

METHODS

The Nationwide Readmissions Database was used to identify patients who underwent ACDF between 2020 and 2022. Patients were stratified as traditional tobacco users, smokeless tobacco users, and tobacco-naive. After propensity score matching, baseline characteristics and postoperative outcomes were compared across cohorts.

RESULTS

There were no differences in postoperative outcomes between smokeless tobacco and tobacco-naive patients. Compared with tobacco-naive patients, cigarette smokers demonstrated higher odds of overall complications (OR=1.49), 180-day mortality (OR=2.72), pulmonary complications (OR=2.01), cardiovascular complications (OR=1.75), surgical complications (OR=1.23), and dysphagia (OR=1.31). Smokeless tobacco users had decreased odds of surgical complications compared with cigarette smokers (OR=0.36).

CONCLUSION

In this national cohort of ACDF patients, smokeless tobacco use was not associated with increased postoperative complications compared with tobacco-naive controls, whereas cigarette smoking demonstrated consistently higher odds of adverse outcomes. When comparing tobacco modalities directly, smokeless tobacco users had no statistically significant difference compared with cigarette smokers for most postoperative complications. Further studies incorporating granular nicotine exposure data, contemporary distinctions among smokeless products, and detailed surgical variables are needed to clarify how the mode of nicotine delivery influences outcomes after ACDF.

LEVEL OF EVIDENCE: Level III.