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We sought to investigate the effect of preoperative polypharmacy (PP) on the 90-day all-cause readmission rate in older adults undergoing corrective surgery for adult spinal deformity.Older adults with a diagnosis of adult spinal deformity undergoing spinal surgery at a quaternary medical center from January 2016 to March 2019 were enrolled in this study. Patients were dichotomized into 2 groups stratified by the number of preoperative prescription medications, with PP defined as 5 or more prescription medications. The primary outcome measure was 90-day all-cause readmission rate. Secondary outcomes included postoperative changes in health-related quality of life measures.Among 161 patients (mean [standard deviation], 69.59 [8.79] years), 97 patients were included in the PP cohort and 64 in the nonpolypharmacy (non-PP) cohort. Both groups were balanced at baseline. Duration of hospital stay (5.82 [1.93] vs. 6.50 [4.00] days), mean number of fusion levels, and duration of surgery were statistically similar between both groups (P0.05). There was no difference in the proportion of patients discharged directly home (31.25% vs. 40.42%, P = 0.36). The 90-day all-cause readmission rate was 3-fold higher in the PP cohort compared with the non-PP cohort. After adjusting for preoperative patient optimization, American Society of Anesthesiologists grade, surgical invasiveness, smoking, depression, and baseline functional disability, older adults with PP had a 9.79 increased odds of 90-day all-cause hospital readmission (P = 0.04). Changes in health-related quality of life measures were similar between both groups.This study's findings indicate that despite preoperative optimization, older adults exposed to polypharmacy are at a significantly increased risk of hospital readmission within 90 days of surgery.

While there are several reports on the impact of smoking tobacco on spinal fusion outcomes, there is minimal literature on the influence of modern smoking cessation therapies on such outcomes. Our study explores the outcomes of single-level lumbar fusion surgery in active smokers and in smokers undergoing recent cessation therapy.MARINER30, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2019. The primary outcomes were the rates of any complication, symptomatic pseudarthrosis, need for revision surgery, and all-cause readmission within 30 and 90 days.The exact matched population analyzed in this study contained 31,935 patients undergoing single-level lumbar fusion with 10,645 (33%) in each of the following groups: (1) active smokers; (2) patients on smoking cessation therapy; and (3) those without any smoking history. Patients undergoing smoking cessation therapy have reduced odds of developing any complication following surgery (odds ratio 0.86, 95% confidence interval 0.80-0.93) when compared with actively smoking patients. Nonsmokers and patients on cessation therapy had a significantly lower rate of any complication compared with the smoking group (9.5% vs. 17% vs. 19%, respectively).When compared with active smoking, preoperative smoking cessation therapy within 90 days of surgery decreases the likelihood of all-cause postoperative complications. However, there were no between-group differences in the likelihood of pseudarthrosis, revision surgery, or readmission within 90 days.

While several studies explore the impact of smoking tobacco on spinal fusion outcomes, there is a paucity of literature on the influence of modern smoking cessation therapies on such outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF).Our study explores the outcomes of single-level ACDF surgery in nonsmokers, active smokers, and smokers undergoing cessation therapy.MARINER30, an all-payer claims database, was utilized to identify patients undergoing single-level ACDF between 2010 and 2019. The primary outcomes were the rates of composite surgical complications, dysphagia, hematoma, symptomatic pseudarthrosis, instrumentation removal, need for revision surgery, and all-cause readmission rates within 30 and 90-days.The matched population consisted of 5769 patients undergoing single-level ACDF with 1923 (33.33%) in each of the following groups: (1) nonsmokers; (2) active smokers; and (3) patients undergoing smoking cessation therapy. Nonsmokers had significantly lower rates of composite surgical complications (3.74% vs 13.05% vs 15.08%), revision surgery (4.06% vs 20.07% vs 22.88%), instrumentation removal (0.83% vs. 2.08% vs. 2.76%), and dysphagia (0.36% vs 0.99% vs 0.62%) when compared to patients in the active smoking and smoking cessation groups, respectively.Patients using smoking cessation therapy were more likely to develop postoperative dysphagia and undergo revision surgery when compared to their actively smoking counterparts. While surgeons routinely recommend smoking cessation prior to surgery, the effects of smoking cessation therapies on surgical outcomes are not well characterized.