Xu Bin, Anderson David B, Park Eun-Sun, Chen Lingxiao, Lee Jae Hyup
Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
EClinicalMedicine. 2021 Oct 31;42:101179. doi: 10.1016/j.eclinm.2021.101179. eCollection 2021 Dec.
We aimed to comprehensively evaluate the associations between (i) smoking, (ii) preoperative smoking cessation time, (iii) nicotine replacement therapy (NRT), (iv) vaping, and (v) alcohol consumption and non-pathological fracture healing in adult patients. We also assessed the impacts of preoperative smoking cessation time, NRT, and vaping on wound healing and wound complications after any sort of surgery.
We searched the MEDLINE, Embase, Cochrane CENTRAL, CINAHL, and AMED electronic databases from their inceptions until August 9th, 2021. Primary outcomes included delayed union rate, nonunion rate, and time to union. A random effects model was used. (Protocol registration: PROSPERO-CRD42019131454).
One hundred and twenty-two studies with 417,767 patients were eligible for the systematic review and 71 of the studies with 39,920 patients were eligible for the meta-analysis. After non-pathological fracture treatment, the nonunion rate was significantly greater in the smoker group than in the non-smoker group (odds ratio [OR], 2·50, 95% confidence interval [1·73-3·61]); additionally, there was no significant difference in the nonunion rate (OR, 0·97 [0·40-2·38]) between the alcohol drinker group and the non-drinker group. The rate of wound infection after surgery was significantly reduced in the smoking cessation group (≥four weeks before surgery) compared to the continuous smoker group (OR, 0·37 [0·16-0·89]).
Smoking is associated with higher rates of nonunion and deep surgical site infection after non-pathological fracture treatment. Smoking cessation (≥four weeks before surgery) is associated with a decreased rate of postoperative wound infection.
The China Scholarship Council (no. 201809120013).
我们旨在全面评估（i）吸烟、（ii）术前戒烟时间、（iii）尼古丁替代疗法（NRT）、（iv）电子烟使用以及（v）饮酒与成年患者非病理性骨折愈合之间的关联。我们还评估了术前戒烟时间、NRT和电子烟使用对任何类型手术后伤口愈合及伤口并发症的影响。
我们检索了MEDLINE、Embase、Cochrane CENTRAL、CINAHL和AMED电子数据库，检索时间从各数据库建库起至2021年8月9日。主要结局包括骨不连发生率、骨不愈合率和骨愈合时间。采用随机效应模型。（方案注册号：PROSPERO-CRD42019131454）。
122项研究（涉及417,767例患者）符合系统评价的纳入标准，71项研究（涉及39,920例患者）符合荟萃分析的纳入标准。非病理性骨折治疗后，吸烟者组的骨不愈合率显著高于非吸烟者组（比值比[OR]为2.50，95%置信区间[1.73 - 3.61]）；此外，饮酒者组与非饮酒者组之间的骨不愈合率无显著差异（OR为0.97[0.40 - 2.38]）。与持续吸烟者组相比，戒烟组（术前≥四周）术后伤口感染率显著降低（OR为0.37[0.16 - 0.89]）。
吸烟与非病理性骨折治疗后较高的骨不愈合率和深部手术部位感染率相关。术前戒烟（术前≥四周）与术后伤口感染率降低相关。
国家留学基金管理委员会（编号：201809120013）。
