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Association of Nontobacco Nicotine Dependence with Postoperative Complications After Distal Radius ORIF: A
Umar Ghilzai1, Jad J Lawand2, Abdullah Ghali1
1Joseph Barnhart Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX.
Purpose:
Distal radius fractures are common, with management varying by age, activity level, and fracture characteristics. Although operative treatment can improve early recovery, it may be associated with complications. Nontobacco nicotine dependence (NTND), through products like e-cigarettes, has increased, but its impact on postoperative outcomes remains underexplored. This study investigated the effect of NTND on complications following distal radius fracture open reduction and internal fixation (ORIF).
Methods:
A retrospective cohort study using the TriNetX database categorized adult patients undergoing distal radius ORIF into NTND and non-NTND cohorts. Propensity score matching accounted for demographic and comorbidity differences. Outcomes assessed included 90-day complications (skin infection; sepsis, defined as systemic infection; wrist stiffness; wound disruption; deep vein thrombosis; acute kidney disease; stroke; myocardial infarction; pulmonary embolism; and chronic regional pain syndrome) and 2-year complications (loosening of ORIF hardware, wrist stiffness, nonunion, nerve injury, and tendon injury).
Results:
After propensity matching, 3,034 patients were matched to each cohort. At 90 days, NTND patients had significantly higher risks of skin infection (OR, 2.48; 95% CI, 1.58-3.89) and lower risk of postoperative stiffness (OR, 0.77; 95% CI, 0.66-0.91). At 2 years, NTND patients exhibited increased risks of loosening of ORIF hardware (OR, 1.66; 95% CI, 1.07-2.60) and nonunion (OR, 2.35; 95% CI, 2.37-4.13), a lower risk of wrist stiffness (OR, 0.78; 95% CI, 0.67-0.91). No statistically significant differences were observed for malunion, tendon ruptures, or nerve injury.
Conclusions:
The NTND is associated with significantly higher risk of postoperative complications following distal radius ORIF, including infection, loosening of ORIF hardware, and nonunion but a lower risk of wrist stiffness. These findings suggest that NTND is an important risk factor and highlights the need for further research and targeted perioperative management strategies to mitigate risks in this population.
Type Of Study/Level Of Evidence:
Prognostic II.
