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To quantify the increased risk smokers have of experiencing a delayed and\/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study eligibility criteria, participants and interventions<\/jats:title>\n                    <jats:p>Observational cohort studies that reported adult smokers and non-smokers with delayed and\/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and outcome measures<\/jats:title>\n                    <jats:p>2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and\/or non-union were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and\/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and\/or non-union. In all the subgroups, the increased risk was always \u22651.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7\u2005days (14.2 to 41.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-010303","type":"journal-article","created":{"date-parts":[[2016,11,14]],"date-time":"2016-11-14T20:30:34Z","timestamp":1479155434000},"page":"e010303","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":153,"title":["Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? 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