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The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: Determine if tobacco use is associated with increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery. METHODS: Databases were queried to identify cohort studies that directly compared smo...

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Autores principales: Nunna, Ravi S., Ansari, Darius, Ostrov, Philip B., Dettori, Joseph R., Godolias, Periklis, Ortiz-Torres, Michael, Elias, Elias, Gruber, Max, Oskouian, Rod J., Chapman, Jens R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837502/
https://www.ncbi.nlm.nih.gov/pubmed/36367824
http://dx.doi.org/10.1177/21925682221110127
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author Nunna, Ravi S.
Ansari, Darius
Ostrov, Philip B.
Dettori, Joseph R.
Godolias, Periklis
Ortiz-Torres, Michael
Elias, Elias
Gruber, Max
Oskouian, Rod J.
Chapman, Jens R.
author_facet Nunna, Ravi S.
Ansari, Darius
Ostrov, Philip B.
Dettori, Joseph R.
Godolias, Periklis
Ortiz-Torres, Michael
Elias, Elias
Gruber, Max
Oskouian, Rod J.
Chapman, Jens R.
author_sort Nunna, Ravi S.
collection PubMed
description STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: Determine if tobacco use is associated with increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery. METHODS: Databases were queried to identify cohort studies that directly compared smokers with non-smokers and provided the absolute number of adverse events and the population at risk. Data quality was evaluated using the Quality in Prognosis Studies tool. Risk ratios (RR) and 95% confidence intervals were calculated and compared between studies. The grading of recommendation, assessment, development and evaluation (GRADE) criteria were used to assess the strength of the evidence. RESULTS: Seventeen studies assessing 37 897 participants met the inclusion criteria. Of these, 10 031 (26.5%) were smokers and 27 866 (73.5%) were nonsmokers. The mean age for the study population was 58 years, and 45% were males. Smoking was not associated with increased risk of one or more major adverse events within 90 days following spine surgery (seven studies, pooled RR 1.13, 95% CI [.75-1.71], I2 = 41%). However, smoking was significantly associated with one or more major adverse events in ≤2 level fusion (three studies, pooled RR 2.46, 95% CI [1.18-5.12], I2 = 0%), but not in fusions of ≥3 levels (four studies, pooled RR .87, 95% CI [.70-1.08], I2 = 0%). Additionally, there was no statistically significant association between smoking and any adverse event, nor increased reoperation risk due to adverse events. CONCLUSIONS: In this meta-analysis, tobacco use was not associated with a statistically significant increased risk of adverse events within 90 days in patients undergoing spinal fusion surgery. Our results are limited by the variable reporting methodology for both complication rates as well as smoking incidence between the included individual studies.
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spelling pubmed-98375022023-01-14 The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis Nunna, Ravi S. Ansari, Darius Ostrov, Philip B. Dettori, Joseph R. Godolias, Periklis Ortiz-Torres, Michael Elias, Elias Gruber, Max Oskouian, Rod J. Chapman, Jens R. Global Spine J EBSJ - Review STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: Determine if tobacco use is associated with increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery. METHODS: Databases were queried to identify cohort studies that directly compared smokers with non-smokers and provided the absolute number of adverse events and the population at risk. Data quality was evaluated using the Quality in Prognosis Studies tool. Risk ratios (RR) and 95% confidence intervals were calculated and compared between studies. The grading of recommendation, assessment, development and evaluation (GRADE) criteria were used to assess the strength of the evidence. RESULTS: Seventeen studies assessing 37 897 participants met the inclusion criteria. Of these, 10 031 (26.5%) were smokers and 27 866 (73.5%) were nonsmokers. The mean age for the study population was 58 years, and 45% were males. Smoking was not associated with increased risk of one or more major adverse events within 90 days following spine surgery (seven studies, pooled RR 1.13, 95% CI [.75-1.71], I2 = 41%). However, smoking was significantly associated with one or more major adverse events in ≤2 level fusion (three studies, pooled RR 2.46, 95% CI [1.18-5.12], I2 = 0%), but not in fusions of ≥3 levels (four studies, pooled RR .87, 95% CI [.70-1.08], I2 = 0%). Additionally, there was no statistically significant association between smoking and any adverse event, nor increased reoperation risk due to adverse events. CONCLUSIONS: In this meta-analysis, tobacco use was not associated with a statistically significant increased risk of adverse events within 90 days in patients undergoing spinal fusion surgery. Our results are limited by the variable reporting methodology for both complication rates as well as smoking incidence between the included individual studies. SAGE Publications 2022-11-11 2023-01 /pmc/articles/PMC9837502/ /pubmed/36367824 http://dx.doi.org/10.1177/21925682221110127 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle EBSJ - Review
Nunna, Ravi S.
Ansari, Darius
Ostrov, Philip B.
Dettori, Joseph R.
Godolias, Periklis
Ortiz-Torres, Michael
Elias, Elias
Gruber, Max
Oskouian, Rod J.
Chapman, Jens R.
The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis
title The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis
title_full The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis
title_fullStr The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis
title_full_unstemmed The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis
title_short The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis
title_sort risk of adverse events in smokers undergoing spinal fusion: a systematic review and meta-analysis
topic EBSJ - Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837502/
https://www.ncbi.nlm.nih.gov/pubmed/36367824
http://dx.doi.org/10.1177/21925682221110127
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