{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T19:03:04Z","timestamp":1784919784408,"version":"3.55.0"},"reference-count":55,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T00:00:00Z","timestamp":1668124800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Determine if tobacco use is associated with increased risk of postoperative adverse events within 90\u00a0days in patients undergoing spinal fusion surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Databases were queried to identify cohort studies that directly compared smokers with non-smokers and provided the absolute number of adverse events and the population at risk. Data quality was evaluated using the Quality in Prognosis Studies tool. Risk ratios (RR) and 95% confidence intervals were calculated and compared between studies. The grading of recommendation, assessment, development and evaluation (GRADE) criteria were used to assess the strength of the evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen studies assessing 37\u00a0897 participants met the inclusion criteria. Of these, 10\u00a0031 (26.5%) were smokers and 27\u00a0866 (73.5%) were nonsmokers. The mean age for the study population was 58\u00a0years, and 45% were males. Smoking was not associated with increased risk of one or more major adverse events within 90\u00a0days following spine surgery (seven studies, pooled RR 1.13, 95% CI [.75-1.71], I2 = 41%). However, smoking was significantly associated with one or more major adverse events in \u22642 level fusion (three studies, pooled RR 2.46, 95% CI [1.18-5.12], I2 = 0%), but not in fusions of \u22653 levels (four studies, pooled RR .87, 95% CI [.70-1.08], I2 = 0%). Additionally, there was no statistically significant association between smoking and any adverse event, nor increased reoperation risk due to adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this meta-analysis, tobacco use was not associated with a statistically significant increased risk of adverse events within 90\u00a0days in patients undergoing spinal fusion surgery. Our results are limited by the variable reporting methodology for both complication rates as well as smoking incidence between the included individual studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682221110127","type":"journal-article","created":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T12:46:49Z","timestamp":1668170809000},"page":"242-253","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2516-5445","authenticated-orcid":false,"given":"Ravi S.","family":"Nunna","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Missouri, Columbia, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2516-6894","authenticated-orcid":false,"given":"Darius","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5121-6587","authenticated-orcid":false,"given":"Philip B.","family":"Ostrov","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0216-8363","authenticated-orcid":false,"given":"Joseph R.","family":"Dettori","sequence":"additional","affiliation":[{"name":"Spectrum Research, Inc, Tacoma, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Godolias","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ortiz-Torres","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Missouri, Columbia, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0339-3666","authenticated-orcid":false,"given":"Elias","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas-Southwestern, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Gruber","sequence":"additional","affiliation":[{"name":"Elson S. Floyd College of Medicine, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod J.","family":"Oskouian","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens R.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,11,11]]},"reference":[{"key":"bibr1-21925682221110127","unstructured":"WHO report on the global tobacco epidemic 2021: Addressing new and emerging products. WHO report on the global tobacco epidemic. 8th ed. 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