Study design Systematic review and meta-analysis. Objective This systematic review with meta-analysis is aimed at evaluating the impact of smoking (tobacco) on spinal fusion rates and the resulting PROMs. Methods Following the PRISMA guidelines, a systematic literature search was conducted in 4 databases. Studies focused on adult smokers vs non-smokers undergoing spinal fusion. Odds ratios (ORs) were calculated for dichotomous variables and mean differences or standardized mean differences for continuous variables. The primary outcomes assessed were non-union/pseudoarthrosis incidence and PROMs. Results A total of 29 studies were included in this analysis. The unadjusted incidence of pseudoarthrosis was significantly higher in smokers than in non-smokers (OR 1.97, 95% CI 1.55-2.52, P < 0.001). Subgroup analysis revealed significant differences in the cervical (OR 2.09, 95% CI 1.27-3.44, P < 0.05) and lumbar (OR 1.97, 95% CI 1.45-2.68, P < 0.001) regions. Adjusted analysis also showed a significantly higher incidence of pseudoarthrosis in smokers (OR 1.38, 95% CI 1.12-1.72, P < 0.05). Changes in ODI, VAS, EQ-5D, and SF-12 and SF-36, consistently favored nonsmoking patients. Smoking was associated with a lower rate of returning to work (OR 0.70, 95% CI 0.54-0.90, P < 0.05), and in the lumbar subgroup, reduced satisfaction (OR 0.24, 95% CI 0.12-0.49, P < 0.001). Former smokers (smoking cessation for at least 1 year prior to surgery) did not show significant differences compared to nonsmokers in terms of pseudarthrosis rate or pain scores. Conclusion Smoking is associated with an increased risk of pseudarthrosis and poorer PROMs after spinal fusion surgery. Healthcare providers should emphasize smoking cessation interventions to improve surgical outcomes and patient satisfaction.
Arnold et al. (Thu,) studied this question.