The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures

Xu, Bin; Anderson, David; Park, Eun-Sun; Chen, Lingxiao; Lee, Jae Hyup

doi:10.1016/j.eclinm.2021.101179

Cited by 28 publications

(18 citation statements)

References 41 publications

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“…22 In addition, Hirche et al 23 demonstrated smoking to be a risk factor for failure of vascularized bone graft treatment for scaphoid nonunion (odds ratio: 6.923, P = 0.029). Xu et al 24 likewise demonstrated higher rates on nonunion and deep surgical site infections after nonpathological bone fractures. Hernigou et al demonstrated that patients who smoke have higher risk of fractures, as well as delayed bone healing after injury.…”

Section: Discussionmentioning

confidence: 94%

The Snuffbox: The Effect of Smokeless Tobacco Use on Scaphoid Fracture Healing

Waters

Collins

Cole

et al. 2023

J Am Acad Orthop Surg

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Background: Smoking has been demonstrated to be a risk factor for nonunion of scaphoid fractures, but it is unclear if chewing tobacco confers similar risk. The purpose of this study was to evaluate rates of bone-related complications after nonsurgical management of scaphoid fractures in smokeless tobacco users compared with matched control subjects and compared with smokers. Methods: A retrospective cohort study was conducted using the PearlDiver database. For patients who underwent nonsurgical management of scaphoid fractures, 212 smokeless tobacco users and 6,048 smokers were matched 1:4 with control subjects (n = 848 and 24,192, respectively) and 212 smokeless tobacco users were matched 1:4 with 848 smokers. Rates of bone-related complications within 2 years of initial injury were compared using multivariable logistic regression. Results: From weeks 12 through 104 after initial injury, compared with control subjects who do not use tobacco, the smokeless tobacco cohort demonstrated markedly higher rates of nonunion (5.7% vs 2.7%, OR: 2.07). Compared with control subjects who do not use tobacco, the smoking cohort demonstrated markedly higher rates of nonunion (4.3% vs 2.6%, OR: 1.91), repair of nonunion (1.5% vs 0.9%, OR: 1.87), and four corner fusion and proximal row carpectomy (0.3% vs 0.1%, OR: 3.17). Smokeless tobacco use was markedly underdiagnosed in the adult male cohort of unilateral scaphoid fractures with 2 years of follow-up found in the database (372 of 25,704, 1.45%) relative to Centers for Disease Control estimates for adult male smokeless tobacco use (4.5%) (P < 0.001). Conclusion: Given the higher rates of nonunion diagnoses after nonsurgical management in this cohort, surgeons should consider asking all patients with scaphoid fractures if they use smokeless tobacco or smoke and consider adding this to the patient's intake history to further identify patients at risk for nonunions. Tobacco cessation counseling is indicated for all tobacco users, including smokeless with scaphoid fractures.

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Section: Discussionmentioning

confidence: 94%

The Snuffbox: The Effect of Smokeless Tobacco Use on Scaphoid Fracture Healing

Waters

Collins

Cole

et al. 2023

J Am Acad Orthop Surg

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“…[40][41][42][43][44][45] Smoking has been associated with surgical site infections, postoperative wound complications, and reoperations after fracture fixation. [46][47][48] Bleeding disorders have been associated with increased risk of major postoperative complications and need for postoperative blood transfusion. 43,49 Dialysis dependency has been associated with greater risk of in-hospital mortality, longer postoperative stay, and reoperations.…”

Section: Discussionmentioning

confidence: 99%

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

Chinta

Fisher

Tejwani

2023

Journal of Orthopaedic Trauma

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Objective: To assess the ability of a modified frailty index (mFI-5) score, which includes the presence of congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status, and to identify patients at increased risk of complications after surgical treatment of long-bone nonunions/malunions. Design: Retrospective. Setting: Hospitals participating in the 2005–2018 American College of Surgeons National Surgical Quality Improvement Program. Patients/Participants: Patients in the American College of Surgeons National Surgical Quality Improvement Program database with upper extremity and lower extremity fractures were enrolled. Intervention: Surgical repair of nonunions/malunions of upper and lower extremity long bones. Main Outcome Measure: Postoperative complications after long-bone nonunion/malunion surgery. Results: Respective univariate analysis of the 2964 UE [1786 (60.3%) with mFI-5 of 0 and 386 (13.0%) with mFI-5 ≥2] and 3305 LE [1837 (55.6%) with mFI-5 of 0 and 498 (15.1%) with mFI-5 ≥2] showed that increasing mFI-5 score was associated with medical complications, extended longer length of stay, adverse discharge, and readmission. Binomial logistic regression showed that UE patients with mFI-5 ≥2 had increased risk of wound complications [odds ratio (OR) 2.512, 95% (confidence interval) CI: 1.037–6.086, P = 0.041), adverse discharge (OR 1.735, 95% CI: 1.204–2.499, P = 0.003), and unplanned readmission (OR 2.102, 95% CI: 1.038–4.255, P = 0.039), while LE patients with mFI-5 ≥2 had an increased risk of medical complications (OR 1.847, 95% CI: 1.307–2.610, P = 0.001), cumulative morbidity (OR 1.835, 95% CI: 1.342–2.510, P < 0.001), extended longer length of stay (OR 1.809, 95% CI: 1.233–2.654, P = 0.002), and adverse discharge (OR 1.841, 95% CI: 1.394–2.432, P < 0.001). Conclusions: mFI-5 score ≥2 is associated with significant increase in postoperative complications after surgical repair of long-bone nonunions/malunions. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…Furthermore, some patients with moderate or severe pulmonary dysfunction, who were excluded from the present study, may not tolerate radical esophagectomy, and neoadjuvant therapy might be considered as an alternative treatment. In short, a history of smoking is a risk factor for post- esophagectomy ETI [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Emergency tracheal intubation peri-operative risk factors and prognostic impact after esophagectomy

Liu

Jin²,

Lin

et al. 2022

BMC Anesthesiol

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Background Emergent endotracheal intubation (ETI) is a serious complication after Oesophagectomy. It is still unclear that perioperative risk factors and prognosis of these patients with ETI. Methods Between January 2015 and December 2018, 21 patients who received ETI after esophagectomy were enrolled (ETI group) at the department of thoracic surgery, Fujian Union hospital, China. Each study subject matched one patient who underwent the same surgery in the current era were included (control group). Patient characteristics and perioperative factors were collected. Results Patients with ETI were older than those without ETI (p = 0.022). The patients with history of smoking in ETI group were significantly more than those in control group (p = 0.013). The stay-time of postanesthesia care unit (PACU) in ETI group was significantly longer than that in control group (p = 0.001). The incidence of anastomotic leak or electrolyte disorder in ETI group was also higher than that in control group (p = 0.014; p = 0.002). Logistic regression analysis indicated history of smoke (HR 6.43, 95%CI 1.39–29.76, p = 0.017) and longer stay time of PACU (HR 1.04, 95%CI 1.01–1.83, p = 0.020) both were independently associated with higher risks of ETI. The 3-year overall survival (OS) rates were 47.6% in patients with ETI and 85.7% in patients without ETI (HR 4.72, 95%CI 1.31-17.00, p = 0.018). COX regression analysis indicated ETI was an independent risk factor affecting the OS. Conclusion The study indicated that history of smoking and longer stay-time in PACU both were independently associated with higher risks of ETI; and ETI was an independent risk factor affecting the OS of patients after esophagectomy. Trial registration This trial was retrospectively registered with the registration number of ChiCTR2000038549.

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The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures

Cited by 28 publications

References 41 publications

The Snuffbox: The Effect of Smokeless Tobacco Use on Scaphoid Fracture Healing

The Snuffbox: The Effect of Smokeless Tobacco Use on Scaphoid Fracture Healing

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

Emergency tracheal intubation peri-operative risk factors and prognostic impact after esophagectomy

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