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- Title
The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis.
- Authors
Nunna, Ravi S.; Ostrov, Philip B.; Ansari, Darius; Dettori, Joseph R.; Godolias, Periklis; Elias, Elias; Tran, Angela; Oskouian, Rod J.; Hart, Robert; Abdul-Jabbar, Amir; Jackson, Keith L.; Devine, John G.; Mehta, Ankit I.; Adogwa, Owoicho; Chapman, Jens R.
- Abstract
Study Design: Systemic review and meta-analysis. Objective: To review and establish the effect of tobacco smoking on risk of nonunion following spinal fusion. Methods: A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception to December 31, 2020, was conducted. Cohort studies directly comparing smokers with nonsmokers that provided the number of nonunions and fused segments were included. Following data extraction, the risk of bias was assessed using the Quality in Prognosis Studies Tool, and the strength of evidence for nonunion was evaluated using the GRADE working group criteria. All data analysis was performed in Review Manager 5, and a random effects model was used. Results: Twenty studies assessing 3009 participants, which included 1117 (37%) smokers, met inclusion criteria. Pooled analysis found that smoking was associated with increased risk of nonunion compared to not smoking ≥1 year following spine surgery (RR 1.91, 95% CI 1.56 to 2.35). Smoking was significantly associated with increased nonunion in those receiving either allograft (RR 1.39, 95% CI 1.12 to 1.73) or autograft (RR 2.04, 95% CI 1.54 to 2.72). Both multilevel and single level fusions carried increased risk of nonunion in smokers (RR 2.30, 95% CI 1.64 to 3.23; RR 1.79, 95% CI 1.12 to 2.86, respectively). Conclusion: Smoking status carried a global risk of nonunion for spinal fusion procedures regardless of follow-up time, location, number of segments fused, or grafting material. Further comparative studies with robust methodology are necessary to establish treatment guidelines tailored to smokers.
- Publication
Global Spine Journal, 2022, Vol 12, Issue 3, p526
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/21925682211046899