Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis.
fracture risk
nonunion risk
smoking
Journal
EFORT open reviews
ISSN: 2058-5241
Titre abrégé: EFORT Open Rev
Pays: England
ID NLM: 101695674
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
entrez:
15
12
2021
pubmed:
16
12
2021
medline:
16
12
2021
Statut:
epublish
Résumé
This systematic review and meta-analysis aimed to analyse negative effects of smoking in orthopaedic and trauma patients.A PubMed search was carried out for studies published until July 2020 regarding effects of smoking on fracture risk, nonunion, infection after orthopaedic surgery, and persisting nonunion after scaphoid nonunion surgery. Random effects models calculated for outcome parameters, and relative risks (RR) with 95% confidence intervals are provided. No adjustments for covariates were made. Heterogeneity was assessed with Higgins' I2, publication bias with Harbord's p (Hp), sensitivity analysis performed on funnel plots and quality of studies was analysed using the Newcastle-Ottawa Scale.Of 3362 retrieved entries, 69 were included in the final analysis. Unadjusted RR for smokers to develop vertebral (six studies, seven entries; RR: 1.61; p = 0.008; I2 = 89.4%), hip (11 studies, 15 entries; RR: 1.28; p = 0.007; I2 = 84.1%), and other fractures (eight studies, 10 entries; RR: 1.75; p = 0.019; I2 = 89.3%) was significantly higher. Postoperative infection risk was generally higher for smokers (21 studies; RR: 2.20; p < 0.001; I2 = 58.9%), and remained upon subgroup analysis for elective spinal (two studies; RR: 4.38; p < 0.001; I2 = 0.0%) and fracture surgery (19 studies; RR: 2.10; p < 0.001; I2 = 58.5%). Nonunion risk after orthopaedic (eight studies; RR: 2.15; p < 0.001; I2 = 35.9%) and fracture surgery (11 studies; RR: 1.85; p < 0.001; I2 = 39.9%) was significantly higher for smokers, as was persisting nonunion risk after surgery for scaphoid nonunion (five studies; RR: 3.52; p < 0.001; I2 = 0.0%). Sensitivity analysis for each model reduced heterogeneity whilst maintaining significance (all I2 < 20.0%).Smoking has a deleterious impact on fracture incidence, and (subsequent) development of nonunions and postoperative infections. Cite this article:
Identifiants
pubmed: 34909221
doi: 10.1302/2058-5241.6.210058
pii: 10.1302_2058-5241.6.210058
pmc: PMC8631245
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
1006-1019Informations de copyright
© 2021 The author(s).
Déclaration de conflit d'intérêts
ICMJE Conflict of interest statement: None of the authors has any conflicts of interest related to the current study to declare.
Références
J Hand Surg Am. 2008 Jul-Aug;33(6):974-9
pubmed: 18656775
Sci Rep. 2019 Feb 13;9(1):1965
pubmed: 30760752
Maturitas. 2017 Mar;97:38-43
pubmed: 28159060
J Hand Surg Br. 2006 Jun;31(3):252-5
pubmed: 16488521
N Engl J Med. 2014 Jan 2;370(1):60-8
pubmed: 24382066
J Orthop Surg Res. 2019 Nov 12;14(1):360
pubmed: 31718660
Surg Neurol Int. 2015 Sep 29;6:154
pubmed: 26500800
Osteoporos Int. 2005 Feb;16(2):155-62
pubmed: 15175845
Am J Med. 1999 Mar;106(3):311-4
pubmed: 10190380
Int Orthop. 2018 Mar;42(3):651-658
pubmed: 29404668
ANZ J Surg. 2019 Jun;89(6):723-728
pubmed: 31087540
Orthop Surg. 2020 Apr;12(2):524-532
pubmed: 32202051
Clin Orthop Relat Res. 1998 Aug;(353):231-7
pubmed: 9728179
Medicine (Baltimore). 2018 Feb;97(7):e9901
pubmed: 29443762
Int Orthop. 2017 Oct;41(10):1965-1982
pubmed: 28744800
Endocrinology. 2002 Sep;143(9):3575-81
pubmed: 12193573
J Bone Miner Res. 2000 Apr;15(4):721-39
pubmed: 10780864
J Am Acad Orthop Surg. 2001 Jan-Feb;9(1):9-17
pubmed: 11174159
J Bone Miner Res. 2005 Jul;20(7):1208-15
pubmed: 15940374
J Orthop Trauma. 2015 Jan;29(1):1-6
pubmed: 25526095
JBMR Plus. 2019 Jan 18;3(6):e10129
pubmed: 31346561
J Bone Miner Res. 2004 Jul;19(7):1172-80
pubmed: 15177001
PLoS One. 2018 May 22;13(5):e0197768
pubmed: 29787613
PLoS One. 2019 Nov 5;14(11):e0224439
pubmed: 31689324
J Orthop Res. 2017 May;35(5):1076-1085
pubmed: 27018317
Bone Joint J. 2017 Feb;99-B(2):225-230
pubmed: 28148665
J Am Acad Orthop Surg. 2012 May;20(5):273-82
pubmed: 22553099
JAMA Surg. 2016 Nov 16;151(11):e162775
pubmed: 27603155
J Hand Surg Am. 2014 Mar;39(3):423-9
pubmed: 24444804
Injury. 2014 Mar;45(3):554-9
pubmed: 24275357
J Hand Surg Am. 2006 Mar;31(3):387-96
pubmed: 16516732
Osteoporos Int. 2002 Aug;13(8):624-9
pubmed: 12181620
J Orthop Trauma. 2003 Nov-Dec;17(10):663-7
pubmed: 14600564
Clin Orthop Relat Res. 2016 Feb;474(2):562-70
pubmed: 26304043
Osteoporos Int. 2016 Mar;27(3):923-931
pubmed: 26537711
Medicine (Baltimore). 2019 Feb;98(7):e14547
pubmed: 30762800
J Hosp Infect. 2017 May;96(1):1-15
pubmed: 28410761
Hip Pelvis. 2017 Sep;29(3):176-181
pubmed: 28955683
Rheumatology (Oxford). 2012 Sep;51(9):1714-20
pubmed: 22661554
J Orthop Sci. 2014 Nov;19(6):973-7
pubmed: 25196794
Cent Afr J Med. 1962 Jun;8:234-6
pubmed: 13891004
J Bone Joint Surg Am. 2013 May 1;95(9):850-9
pubmed: 23636193
J Bone Joint Surg Br. 2007 Dec;89(12):1553-60
pubmed: 18057352
Injury. 2007 May;38 Suppl 2:S3-9
pubmed: 17920415
Medicine (Baltimore). 2017 Nov;96(44):e8411
pubmed: 29095273
J Bone Joint Surg Am. 2014 Apr 16;96(8):674-81
pubmed: 24740664
Int Orthop. 2007 Aug;31(4):503-5
pubmed: 16947049
Evid Rep Technol Assess (Summ). 2001 Feb;(28):1-2
pubmed: 11677787
PLoS One. 2014 Dec 01;9(12):e114016
pubmed: 25436912
Orthop Traumatol Surg Res. 2015 Apr;101(2):197-200
pubmed: 25703151
Int J Tuberc Lung Dis. 2015 May;19(5):603-9
pubmed: 25868031
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2608-15
pubmed: 11034645
J Orthop Trauma. 2018 Jul;32(7):e263-e269
pubmed: 29664881
Life Sci. 2006 Mar 6;78(15):1733-40
pubmed: 16266722
J Bone Joint Surg Am. 2016 Dec 7;98(23):2006-2016
pubmed: 27926682
Stat Med. 2006 Oct 30;25(20):3443-57
pubmed: 16345038
Osteoporos Int. 1999;10(6):487-94
pubmed: 10663350
Lancet. 2002 Jun 1;359(9321):1929-36
pubmed: 12057569
Plast Reconstr Surg. 1978 Apr;61(4):570-5
pubmed: 635046
Int Wound J. 2017 Dec;14(6):982-988
pubmed: 28303656
BMJ Open. 2016 Nov 14;6(11):e010303
pubmed: 28186922
Injury. 2014 Oct;45(10):1653-8
pubmed: 25062602
Cureus. 2019 Apr 3;11(4):e4377
pubmed: 31218142
Clin Orthop Relat Res. 2000 Apr;(373):227-32
pubmed: 10810481
J Bone Joint Surg Am. 2014 Mar 5;96(5):403-7
pubmed: 24599202
PLoS One. 2018 Dec 26;13(12):e0209740
pubmed: 30586463
Arch Surg. 1991 Sep;126(9):1131-4
pubmed: 1929845
J Intern Med. 2003 Dec;254(6):572-83
pubmed: 14641798
World Neurosurg. 2017 Nov;107:362-370
pubmed: 28803178
Int Wound J. 2019 Apr;16(2):473-478
pubmed: 30588735
J Bone Joint Surg Br. 2000 Jul;82(5):655-8
pubmed: 10963160
J Bone Joint Surg Am. 2013 Jul 3;95(13):1153-8
pubmed: 23824382
Indian J Orthop. 2018 Jul-Aug;52(4):406-410
pubmed: 30078900
Surgeon. 2020 Apr;18(2):122-128
pubmed: 31543312
Osteoporos Int. 2005 Dec;16(12):2185-94
pubmed: 16177836
Injury. 2007 Mar;38(3):371-7
pubmed: 17070526
J Bone Miner Res. 2005 Jan;20(1):131-40
pubmed: 15619679
J Res Health Sci. 2014 Summer;14(3):193-7
pubmed: 25209905
Arthroscopy. 2015 Nov;31(11):2128-37
pubmed: 26111594
Injury. 2011 Jun;42(6):587-90
pubmed: 21524745
Int Orthop. 2018 Jun;42(6):1397-1403
pubmed: 29270688
J Orthop Trauma. 2011 Dec;25(12):748-55
pubmed: 21886001
Clin Orthop Relat Res. 2019 Apr;477(4):813-820
pubmed: 30811353
Int Wound J. 2018 Dec;15(6):971-977
pubmed: 30091528
Injury. 2013 Nov;44(11):1379-82
pubmed: 24035757
JAMA. 1994 Dec 21;272(23):1825-31
pubmed: 7990216
J Hand Surg Am. 2008 Jul-Aug;33(6):988-97
pubmed: 18656779
J Orthop Trauma. 2013 Sep;27(9):e196-200
pubmed: 23287757
J Bone Miner Res. 1991 Apr;6(4):331-8
pubmed: 1858519
J Orthop Trauma. 2017 Feb;31(2):e37-e42
pubmed: 27755332
Int Wound J. 2018 Apr;15(2):237-242
pubmed: 29193653
J Bone Miner Metab. 2019 Jul;37(4):722-728
pubmed: 30465091
J Hand Surg Am. 2016 Feb;41(2):237-43.e1-2
pubmed: 26686063
J Hand Surg Am. 1980 Jul;5(4):343-54
pubmed: 6999072
Spine (Phila Pa 1976). 2014 Oct 1;39(21):1765-70
pubmed: 25054650
Spine (Phila Pa 1976). 2005 Feb 15;30(4):468-74
pubmed: 15706346
Knee Surg Sports Traumatol Arthrosc. 2011 Mar;19(3):333-9
pubmed: 21153542
J Orthop Sci. 2006 Jul;11(4):424-31
pubmed: 16897211
Prev Chronic Dis. 2008 Jan;5(1):A09
pubmed: 18081998
Epidemiology. 1991 Jan;2(1):16-25
pubmed: 2021661
Arch Intern Med. 2001 Apr 9;161(7):983-8
pubmed: 11295961
Br J Community Nurs. 2003 Dec;8(12):S22-6
pubmed: 14700008
Eur J Orthop Surg Traumatol. 2014 Jul;24(5):797-803
pubmed: 23754632
J Bone Miner Res. 1998 Jun;13(6):918-24
pubmed: 9626622
Arch Osteoporos. 2019 May 29;14(1):57
pubmed: 31144116
J Orthop Surg Res. 2019 Dec 10;14(1):423
pubmed: 31823829
Injury. 2005 Jun;36(6):783-7
pubmed: 15910834
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120