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What is the Association Between Nontobacco Nicotine Dependence and Postoperative Complications in Total Hip
Logan M Good1,2,3, Collin W Blackburn1,2,3, Jeremy M Adelstein1,2,3
1Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Background:
Nontobacco nicotine dependence (NTND) is an increasing alternative to traditional tobacco use. However, limited data exist in NTND patients undergoing total hip arthroplasty (THA). The purpose of this study was to investigate differences in complications and revision rates among patients with and without NTND undergoing THA.
Methods:
The TriNetX US Collaborative Network database was queried using ICD-10 and CPT codes to identify patients aged 18 and older undergoing primary THA between 2014 and 2024. Cohorts were divided depending on history of NTND and propensity-matched based on age, gender, race, ethnicity, body mass index, and comorbidities. Rates of complications and revision THA were compared.
Results:
A total of 99,496,579 patients aged 18 and older were identified, of which 192,826 underwent primary THA. After exclusions, 15,561 (93.2%) were nonnicotine users and 8452 (6.8%) were NTND. After 1:1 propensity score matching, each cohort included 8378 patients. Complications including myocardial infarction, stroke, pneumonia, acute kidney injury, sepsis, emergency department visits, and rehospitalization were significantly higher at 90 days postoperatively in NTND patients (P < .05). At 1 year postoperatively, in addition to these complications, the risk of postoperative deep vein thrombosis ([OR] 1.251; P = .0369) and infection (OR 1.288; P = .045) became significantly higher. Rates of prosthetic joint infection (OR 1.485; P = .004), revision THA (OR 1.868; P = .002), and death (OR 1.575; P = .035) were significantly elevated in NTND patients compared to their counterparts at 90 days, 1 year, and 5 years postoperatively.
Conclusions:
NTND patients have higher rates of infection, revision, mortality, and postoperative complications including DVT, myocardial infarction, stroke, pneumonia, kidney injury, sepsis, infection, and return to the hospital. Providers should counsel NTND patients and consider screening protocols prior to operative management.
Level Of Evidence:
Retrospective cohort study, level of evidence III.
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