Put Down the Tin: Chewing Tobacco Use Is Associated With Worse Outcomes After Primary Lumbar Fusion.

ABSTRACT

STUDY DESIGN: Retrospective study. OBJECTIVE: This study evaluated the impact of chewing tobacco on both medical and spine-related complication rates after spinal lumbar fusions in comparison to both a control cohort and a smoking cohort. SUMMARY OF BACKGROUND DATA Smoking is a prevalent modifiable risk factor that has been demonstrated to be associated with increased complications after lumbar fusion. Although smoking rates have decreased in the United States, chewing tobacco use has not similarly reduced. Despite chewing tobacco delivering up to 4 times the dose of smoking, the impact of chewing tobacco is incompletely understood. METHODS: A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent lumbar spine fusion and used chewing tobacco were matched with a control cohort and a smoking cohort. Medical complications within 90 days after primary lumbar fusion were evaluated, including deep venous thrombosis, acute kidney injury, pulmonary embolism, transfusion, acute myocardial infarction, and inpatient readmission. Spine-related complications were evaluated at 2 years postoperatively, including pseudoarthrosis, incision and drainage (I&D), instrument failure, revision, and infection. RESULTS: After primary lumbar fusion, the chewing tobacco cohort demonstrated significantly higher rates of pseudoarthrosis [odds ratio (OR) 1.41], revision (OR 1.57), and any spine-related complication (OR 1.32) compared with controls. The smoking cohort demonstrated significantly higher rates of pseudoarthrosis (OR 1.88), I&D (OR 1.27), instrument failure (OR 1.39), revision (OR 1.54), infection (OR 1.34), and any spine-related complication (OR 1.77) compared with controls. The chewing tobacco cohort demonstrated significantly lower rates of pseudoarthrosis (OR 0.84), I&D (OR 0.49), infection (OR 0.70), and any spine-related complication (OR 0.81) compared with the smoking cohort. CONCLUSIONS: This study demonstrated that chewing tobacco is associated with higher rates of both spine-related and medical complications after primary lumbar fusion. However, chewing tobacco use is associated with less risk of complications compared with smoking. LEVEL OF EVIDENCE Level III.