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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Non-Tobacco Nicotine Dependence and Rates of Postoperative Complications in Total Knee Arthroplasty: A
Sterling J DeShazo1, Remington C Crossnoe, Luke C Bailey
1From the John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX (DeShazo, Crossnoe, Rogers), the Texas A&M School of Medicine, Health Professions Education Building, Bryan, TX (Bailey), and the Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX (Naeger).
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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