Non-tobacco nicotine dependence is associated with increased postoperative pain and opioid requirement following arthroscopic rotator cuff repair.

Abstract

The increasing prevalence of non-tobacco nicotine dependence (NTND) related to vaping has raised concerns about its potential impact on rotator cuff disease especially given the pain after repair. This study aims to compare the risk of various surgical outcomes in patients with NTND, as compared to a control group without NTND. A retrospective cohort study using the TriNetX database examined patients with full-thickness rotator cuff tears treated arthroscopically from 2004 to 2021. A NTND patient cohort was compared to a non-NTND cohort. Patients were 1:1 propensity matched, controlling for demographics and comorbidities. Ninety-day outcomes measured included postoperative infection, pain, shoulder stiffness, deep vein thrombosis, pulmonary embolism, mononeuropathy, physical therapy, hospital admissions, and emergency visits. Three-year outcomes measured included opioid abuse, shoulder pain, revision surgery, arthrocentesis/injection, and shoulder arthroplasty. Relative risks (RR), 95% confidence intervals (CIs), and P values were calculated to assess the association between NTND and these surgical outcomes. A total of 1,572 patients were included in each group. At 90 days postoperative, the NTND cohort had a significantly higher risk of opioid use with an RR of 1.35 (95% CI: 1.26, 1.46, P < .001), and emergency department visits with an RR of 1.56 (95% CI: 1.20, 2.02, P = .001). There was no significant difference observed between groups in acute postoperative pain (RR: 1.45, 95% CI: 1.01, 2.07, P = .041), postoperative shoulder stiffness (RR: 1.07, 95% CI: 0.81, 1.42, P = .628) and orthopedic aftercare (RR: 1.01, 95% CI: 0.87, 1.17, P = .925). At 3 years postoperative, the NTND cohort had a significantly higher risk of opioid use (RR: 1.15, 95% CI: 1.09, 1.21, P < .001). Following arthroscopic rotator cuff repair, NTND use among patients was associated with a higher risk of emergency department visits in the initial 90 days postoperatively. NTND use was associated with a higher postoperative opioid requirement in the initial 90 days following arthroscopic rotator cuff repair, and this increased narcotic usage was sustained at 3 years postoperatively. Patients should be counseled preoperatively about the elevated risks associated with nontobacco nicotine products.