Non-Tobacco Nicotine Dependence is Associated With Increased Risk of Perioperative Complications and Re-Rupture After...

IntroductionTobacco use is known to have adverse effects on postoperative outcomes after Achilles tendon repair. Non-tobacco nicotine dependence (NTND) is increasing, but its association with outcomes of Achilles tendon repair remains unclear. The purpose of this study was to evaluate the association of NTND on perioperative and long-term outcomes after primary Achilles tendon repair. Study Design. This is a cohort study.MethodsA retrospective cohort study using the TriNetX database was conducted to identify patients who underwent primary Achilles tendon repair from 2004 to 2023. Patients were stratified into NTND (defined by International Classification of Diseases, 10th Revision diagnosis of nicotine dependence after excluding tobacco-specific codes), traditional tobacco nicotine dependent, and non-nicotine control cohorts. Propensity score matching was performed for demographics and comorbidities. Ninety-day and 2-year complications were compared using odds ratios (ORs) with 95% confidence intervals (CIs).ResultsOf 25 874 eligible patients, 1598 (6.2%) had NTND. After matching, 1592 NTND patients were compared with 1592 controls and 1592 tobacco users. Within 90 days, NTND patients demonstrated higher rates of wound dehiscence (OR, 1.98, 95% CI, 1.34-2.92), surgical-site infection (OR, 2.01, 95% CI, 1.32-3.08), emergency department visits (OR, 2.43, 95% CI, 1.84-3.20), and hospitalizations (OR, 3.35, 95% CI, 1.87-5.99) versus controls. Compared with tobacco users, NTND patients had greater odds of wound dehiscence (OR, 1.45, 95% CI, 1.02-2.06) and infection (OR, 1.89, 95% CI, 1.25-2.87). At 2 years, NTND patients showed higher re-rupture rates than both controls (OR, 1.39, 95% CI, 1.01-1.89) and tobacco users (OR, 1.62, 95% CI, 1.17-2.25)ConclusionNon-tobacco nicotine dependence was associated with increased short- and long-term complications after primary Achilles tendon repair. These findings identify NTND as a potential risk factor in patients undergoing Achilles tendon repair.Level of Evidence:3; retrospective cohort study.