Impact of Nicotine Dependence on Postoperative Outcomes in Pilon Fracture Open Reduction and Internal Fixation: A Comparative Cohort Analysis.

Abstract

To examine postoperative complication rates in patients with nicotine dependence compared to non-users to clarify the risks in pilon fracture recovery. Design: Retrospective cohort analysis. Data from the TriNetX Health Research Network. Patients aged 18 years or older who underwent open reduction internal fixation (ORIF) for OTA/AO type 43 pilon fractures between 2000 and 2022 were categorized into nicotine-dependent and non-dependent groups. Primary outcomes included rates of malunion, nonunion, mechanical complications such as internal fixation failure or removal, and need for revision surgery by 2-year follow-up. Secondary outcomes over a 90-day period included wound disruption, infection, sepsis, and thrombotic events. Statistical analysis calculated risk ratios and odds ratios, with significance set at P < 0.05. After propensity score matching (N = 4,371 patients in each cohort), the mean age was 44.4 ± 14.5 years in Cohort 1 and 44.7 ± 15.7 years in Cohort 2. Female patients comprised 34.9% of Cohort 1 and 35.3% of Cohort 2. Nicotine dependence was associated with increased risks of mechanical complications (5.8% vs. 4.4%; P = 0.003), malunion/nonunion (6.3% vs. 4.7%; P = 0.002), wound disruption (4.5% vs. 3.2%; P = 0.002), and a higher infection rate (5.7% vs. 3.7%; P < 0.001). Conversely, the incidence of pulmonary embolism was lower in nicotine users (0.3% vs. 0.7%; P = 0.005). Nicotine dependence showed significantly elevated risk of adverse postoperative outcomes in pilon fracture surgeries, including mechanical failure, wound complications, and infection. However, the incidence of pulmonary embolism was lower among nicotine users. These results underscored an association between preoperative nicotine dependence and postoperative complications. Level III, Prognostic.