To determine the impact of smoking on intensive care unit (ICU) outcomes in patients that underwent operative fixation for spine trauma DESIGN:: Retrospective cohort study SETTING:: Single academic level I trauma center PATIENTS:: 181 consecutive surgical spine trauma patients from January 2010 to December 2014 requiring ICU stay.
Patients with smoking history compared to patients with no prior smoking history MAIN OUTCOME MEASUREMENTS:: ICU length of stay, post-operative complications RESULTS:: There were 297 spine trauma patients identified, of which 181 had an ICU stay (61%). There were 96 patients in the smoker cohort (53%) and 85 in the nonsmoker cohort (47%). On univariate analysis, the smoking cohort had a significantly longer ICU length of stay (11.0±12.0 days vs. 8.01±7.98 days, p=0.046).Adjusting for confounders, smoking (Beta: 3.99, p=0.023), age ≥65 years (Beta: 7.61, p=0.001), body mass index≥30 (Beta: 4.47, p=0.010), and American Spinal Injury Association (ASIA) Impairment Scale (Beta: -1.39, p=0.013) were independently associated with increased ICU length of stay.Smoking was not significantly associated with pneumonia (p=0.238) or ARDS (p=0.387) on multivariate analysis.
A history of smoking, older age, obesity, and increasing ASIA Impairment Scale were independently associated with increased ICU length of stay in patients with surgical spine trauma. This study highlights the healthcare burden of smoking in the trauma population, and may help physicians triage scarce ICU resources.
Prognostic Level III.