Impact of Non-Tobacco Nicotine Dependence on Outcomes Following Arthroscopic Partial Meniscectomy

Non-tobacco nicotine dependence (NTND) from products like electronic cigarettes and pouches is rapidly rising. Smoking can negatively impact outcomes following arthroscopic partial meniscectomy (APM), but literature on NTND is sparse. The purpose of this study was to compare outcomes following APM in patients with and without NTND.

The TriNetX database was queried to identify patients older than 18 years who underwent isolated primary APM. Patients were stratified into 2 cohorts based on NTND history and underwent 1:1 propensity score matching on demographics, substance use, and comorbidities. Outcomes included (1) postoperative complications and health care use within 90 days, (2) opioid prescriptions within 1 year, and (3) subsequent knee surgery within 2 years. Subgroup analyses compared ipsilateral revision meniscus surgery rates and opioid prescriptions in opioid-naive patients.

Within 90 days, patients with NTND (n = 9,594), compared to those without (n = 9,594), had higher rates of emergency department visits (P < .001), outpatient visits (P = .015), and pneumonia (P = .011). More patients with NTND were prescribed opioids at all time points within 1 year (P < .001), and they received more prescriptions starting at 1 month (all P ≤ .006). More opioid-naive patients with NTND were prescribed opioids starting at 1 month postoperatively (P < .05). Patients with NTND had higher rates of subsequent meniscus surgery at 1 year (P = .004) and 2 years (P < .001) but no differences in revision rates.

NTND is associated with higher rates of health care use, complications, subsequent meniscus surgery, and opioid prescriptions, including among opioid-naive patients, following APM. Preoperative nicotine screening and patient education are warranted.