The Smokeless Paradox: Nontobacco Nicotine Use and Complications in Anterior Cervical Discectomy and Fusion

Cervical fusion surgeries are commonly performed to stabilize the spine and relieve pain from various conditions. Recent increases in nontobacco nicotine product use, such as electronic cigarettes, present new challenges because of their unknown effects on spinal fusion outcomes. Our study aims to explore the effect of nontobacco nicotine dependence (NTND) on the success of cervical spinal fusions.

We analyzed TriNetX database data for patients undergoing primary anterior cervical diskectomy and fusion, identified by specific Current Procedural Terminology codes, and categorized into cohorts based on a preoperative diagnosis of nicotine dependence, excluding those with tobacco use or dependence. Propensity matching in the ratio of 1:1 was done to control for demographics and body mass index. We analyzed 90-day medical and 2-year implant complications using chi-squared exact tests and univariate regressions within the matched cohorts.

The NTND and control cohorts comprised 5,331 and 43,033 patients, respectively. Five thousand two hundred thirty-two matched pairs of patients were included from each cohort as shown in Table 1 . Our results indicate notable disparities in complications within 90 days postoperation between the cohorts. The NTND cohort had higher risks for opioid use (85.6% vs. 80.3%, P < 0.001), emergency department visits (13.0% vs. 8.40%, P < 0.001), opioid abuse (0.4% vs. 0.2%, P < 0.001), inpatient hospitalizations (20.0% vs. 17.4%, P < 0.001), and sepsis (1.40% vs. 0.80%, P = 0.01). At the 2-year follow-up, increases were observed in pseudarthrosis (14.0% vs. 9.60%, P < 0.001), adjacent segment disease (3.70% vs. 2.20%, P < 0.001), dysphagia (8.90% vs. 6.3%, P = 0.001), and revision surgery (2.00% vs. 1.40%, P = 0.02).

This study highlights notable postoperative complications in patients with NTND undergoing cervical spinal fusion.