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

Area of Science:

• Spine Surgery
• Public Health
• Clinical Research

Background:

• Tobacco use is a common risk factor for surgical complications.
• The impact of smoking on outcomes following spinal fusion surgery requires clarification.

Purpose of the Study:

• To determine if tobacco use is associated with an increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery.

Main Methods:

• A systematic review and meta-analysis of cohort studies comparing smokers and non-smokers undergoing spinal fusion.
• Included studies provided data on adverse events and population risk.
• Risk ratios (RR) and 95% confidence intervals (CI) were calculated using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) criteria.

Main Results:

• Seventeen studies with 37,897 participants were analyzed.
• Overall, smoking was not associated with a significantly increased risk of major adverse events (pooled RR 1.13, 95% CI [0.75-1.71]).
• Smoking was associated with increased adverse events in ≤2 level fusions (RR 2.46, 95% CI [1.18-5.12]) but not in ≥3 level fusions (RR 0.87, 95% CI [0.70-1.08]).

Conclusions:

• Tobacco use was not significantly associated with increased 90-day adverse events after spinal fusion surgery.
• The findings suggest a potential increased risk for limited-level fusions.
• Study limitations include variable reporting of complication and smoking data.