Smolle Maria Anna, Leitner Lukas, Böhler Nikolaus, Seibert Franz-Josef, Glehr Mathias, Leithner Andreas
Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria.
EFORT Open Rev. 2021 Nov 19;6(11):1006-1019. doi: 10.1302/2058-5241.6.210058. eCollection 2021 Nov.
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: 2021;6:1006-1019. DOI: 10.1302/2058-5241.6.210058.
本系统评价和荟萃分析旨在分析吸烟对骨科和创伤患者的负面影响。在PubMed上检索了截至2020年7月发表的关于吸烟对骨折风险、骨不连、骨科手术后感染以及舟状骨骨不连手术后持续性骨不连影响的研究。对结局参数计算随机效应模型，并提供95%置信区间的相对风险（RR）。未对协变量进行调整。使用Higgins' I2评估异质性，使用Harbord's p（Hp）评估发表偏倚，在漏斗图上进行敏感性分析，并使用纽卡斯尔-渥太华量表分析研究质量。在检索到的3362条条目中，最终纳入分析69条。吸烟者发生椎体骨折（6项研究，7条记录；RR：1.61；p = 0.008；I2 = 89.4%）、髋部骨折（11项研究，15条记录；RR：1.
