Impact of Non-Tobacco Nicotine Dependence on Fusion Success and Complications in Midfoot Arthrodesis
Joydeep Baidya, Kush Mody, Anish Ponna, Micah Kranzel, Nana Amponsah, Grant Thomas, Kaushal Upadhyay, David Pedowitz, Joseph Daniel, Selene G. ParekhBackground
Non-tobacco nicotine dependence (NTND) products, such as vaping, nicotine patches/pouches, gum, and lozenges, have become increasingly prevalent. While the negative effects of cigarette smoking on bone healing are well established, the impact of NTND on surgical outcomes remain unclear, particularly in foot and ankle surgery. This study aimed to evaluate the effect of NTND on short- and long-term postoperative complications following midfoot arthrodesis, a procedure commonly performed for arthritis, trauma, and congenital deformities.
Methods
This retrospective cohort study was conducted utilizing the TriNetX database. Patients undergoing midfoot arthrodesis were identified and stratified into NTND (ICD-10: F17, excluding tobacco-specific codes) and nonsmoker cohorts. 1:1 propensity score matching was performed based on demographic and comorbid variables. Postoperative complications were assessed at both 90 days and 2 years utilizing risk ratios (RRs) and 95% confidence intervals (CIs).
Results
After matching, 1235 patients were included in each cohort. At 90 days, NTND patients had significantly higher rates of opioid prescriptions (RR 1.18, 95% CI: 1.11-1.26), emergency department visits (RR 1.52, 95% CI: 1.20-1.93), hospitalizations (RR 1.59, 95% CI: 1.28-1.99), postoperative infections (RR 1.95, 95% CI: 1.13-3.37), and wound complications (RR 1.72, 95% CI: 1.14-2.58) (all P < .05). At 2 years, NTND was associated with increased rates of pseudoarthrosis (RR 1.27, 95% CI: 1.06-1.51) and mechanical implant failure (RR 1.39, 95% CI: 1.11-1.75) (both P < .05).
Conclusion
Non-tobacco nicotine dependence is associated with significantly increased risk of both early and late postoperative complications following midfoot arthrodesis. These findings suggest that vaping may adversely affect bone healing and implant integrity. Surgeons should incorporate NTND screenings and cessation counseling into preoperative planning to optimize patient outcomes.
Level of Evidence: