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Comparative Study
. 2024 Nov 15;32(22):1032-1037.
doi: 10.5435/JAAOS-D-23-01053. Epub 2024 May 2.

Non-Tobacco Nicotine Dependence and Rates of Postoperative Complications in Total Knee Arthroplasty: A Propensity-Matched Comparison

Sterling J DeShazo  1 , Remington C Crossnoe, Luke C Bailey, Jackson M Rogers, Patrick A Naeger
Affiliations
Comparative Study

Non-Tobacco Nicotine Dependence and Rates of Postoperative Complications in Total Knee Arthroplasty: A Propensity-Matched Comparison

Sterling J DeShazo et al. J Am Acad Orthop Surg. .

Abstract

Introduction: Tobacco use elevates the incidence of postoperative complications and remains a key modifiable risk factor of perioperative surgical optimization. It remains unclear whether non-tobacco nicotine dependence confers an increased risk of surgical complications. This study evaluates postoperative complications in patients with non-tobacco nicotine dependence for total knee arthroplasty (TKA).

Methods: We queried the TriNetX health database using Current Procedural Terminology and International Classification of Diseases, 10th Revision (ICD-10) codes and identified two cohorts for evaluation. Cohort A was defined as patients who had a TKA; had a dependence on nicotine; did not have nicotine dependence to cigarettes, chewing tobacco, other tobacco products; and were between the ages of 35 and 90 years. Cohort B was defined as patients who had a TKA but did not have a dependence on nicotine or a personal history of nicotine dependence and were between the ages of 35 and 90 years.

Results: This study analyzed a total of 10,594 non-tobacco nicotine-dependent patients and 175,079 non-dependent patients who underwent TKA. In the analysis of propensity-matched cohorts, non-tobacco nicotine-dependent patients demonstrated an increased rate of various postoperative complications within 90 days. Dependent patients saw a significantly increased risk of infection after a procedure ( P < 0.001), deep vein thrombosis ( P < 0.001), pulmonary embolism ( P < 0.001), sepsis ( P = 0.0065), and prosthetic joint infection ( P = 0.0361) and a higher 3-year revision rate ( P = 0.0084).

Discussion: Non-tobacco nicotine dependence demonstrated an increased associated risk of postoperative surgical complications for patients undergoing TKA. Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol.

Level of evidence: Level III, Prognostic.

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Conflict of interest statement

Declarations of interest: None.

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