Chewing tobacco use is associated with increased perioperative complications after arthroscopic rotator cuff repair

Arthroscopic rotator cuff repair (RCR) is a common and effective treatment used to treat rotator cuff tears. Cigarette smoking is a known modifiable risk factor for poor outcomes after RCR. However, the relationship between chewing tobacco and outcomes after RCR has not been established in the literature. The purpose of this study was to assess the incidence of perioperative/postoperative complications and reoperation rate among patients who use chewing tobacco and undergo RCR.

A comparative study was conducted using a large national insurance database. Patients who underwent RCR with at least 2 years of follow-up data were included. Smokeless tobacco and cigarette users were identified by patients who had the International Classification of Disease (ICD) code ICD-10-D-F17220 and ICD-10-D-F17210, respectively. Smokeless tobacco users and cigarette smokers were matched to nonuser controls based on demographic variables and comorbidities. Smokeless tobacco users were also matched to cigarette smokers. There were no differences in age, sex, and Elixhauser Comorbidity Index between groups. Postoperative complications within 90 days and reoperations within 2 years were compared between groups. A Bonferroni correction was applied, and a P value of < .006 was used as the cutoff for statistical significance.

Within 90 days after RCR, chewing tobacco users had an increased risk of surgical site infection (0.8% vs. 0.3%; odds ratio [OR]: 3.75), venous thromboembolism (1.3% vs. 0.4%; OR: 4.09), pneumonia (2.7% vs. 0.7%; OR: 4.76), acute kidney injury (2.9% vs. 0.7%; OR: 6.84), myocardial infarction (1.1% vs. 0.2%; OR: 6.68), and emergency department utilization (19.3% vs. 8.3%; OR: 3.11) compared with nonuser controls. When compared with cigarette smokers, chewing tobacco users had an increased risk of infection (0.9% vs. 0.3%; OR: 3.25), venous thromboembolism (1.5% vs. 0.7%; OR: 3.08), pneumonia (2.9% vs. 1.2%; OR: 2.97), acute kidney injury (3.3% vs. 0.9%; OR: 4.76), myocardial infarction (1.0% vs. 0.4%; OR: 2.75), and emergency department utilization (20.2% vs. 14.9%; OR: 1.97) within 90 days. Chewing tobacco use was not associated with an increased risk of receiving an ipsilateral total shoulder arthroplasty compared with nonuser controls within 2 years. There were no significant differences in subsequent reoperations between chewing tobacco users and cigarette smokers within 2 years.

Chewing tobacco use is associated with increased risk of medical complications and emergency department utilization after an RCR compared with nonuser controls and cigarette users. This study demonstrates the importance of preoperative screening for chewing tobacco in patients undergoing RCR.