Evidence map›Paper›PMID 34583570›Full record

ArticleGlobal spine journal2022

The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis.

Ravi S Nunna, Philip B Ostrov, Darius Ansari, Joseph R Dettori, Periklis Godolias, Elias Elias, Angela Tran, Rod J Oskouian, Robert Hart, Amir Abdul-Jabbar and 5 more

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In one paragraph

Article in Global spine journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Ravi S Nunna7287Swedish Neuroscience Institute, Seattle, WA, USA.ORCID https://orcid.org/0000-0003-2516-5445
Philip B Ostrov12247University of Illinois at Chicago College of Medicine, Chicago, IL, USA.ORCID https://orcid.org/0000-0002-5121-6587
Darius Ansari12247University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Joseph R DettoriSpectrum Research, Inc, Tacoma, WA, USA.ORCID https://orcid.org/0000-0002-0216-8363
Periklis Godolias7287Swedish Neuroscience Institute, Seattle, WA, USA.
Elias Elias7287Swedish Neuroscience Institute, Seattle, WA, USA.ORCID https://orcid.org/0000-0003-0339-3666
Angela Tran7287Swedish Neuroscience Institute, Seattle, WA, USA.
Rod J Oskouian7287Swedish Neuroscience Institute, Seattle, WA, USA.
Robert Hart7287Swedish Neuroscience Institute, Seattle, WA, USA.
Amir Abdul-Jabbar7287Swedish Neuroscience Institute, Seattle, WA, USA.ORCID https://orcid.org/0000-0001-6613-3111
Keith L Jackson19911Dwight David Eisenhower Army Medical Center, Fort Gordon, GA, USA.ORCID https://orcid.org/0000-0002-3883-8760
John G Devine1421Augusta University, Augusta, GA, USA.ORCID https://orcid.org/0000-0002-8958-2996
Ankit I Mehta12247University of Illinois at Chicago College of Medicine, Chicago, IL, USA.ORCID https://orcid.org/0000-0001-6931-6095
Owoicho Adogwa25989University of Texas Southwestern Medical Center, Dallas, TX, USA.ORCID https://orcid.org/0000-0001-9403-2799
Jens R Chapman7287Swedish Neuroscience Institute, Seattle, WA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

designSystemic review and meta-analysis.

objectiveTo review and establish the effect of tobacco smoking on risk of nonunion following spinal fusion.

methodsA 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.

resultsTwenty 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).

conclusionSmoking 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.

Indexed as

fusionmeta-analysisnicotinenonunionpseudarthrosissmokingsystematic reviewtobacco

Identifiers

PMID34583570
PMCPMC9121161

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.