Increased Postoperative Complications in Non-Tobacco Nicotine Users Following Total Hip Arthroplasty.

Abstract

Nicotine use is associated with increased complications after total joint arthroplasty, but data on non-tobacco nicotine dependence (NTND), including vaping and smokeless nicotine, are limited. This study evaluated peri- and postoperative outcomes in NTND patients undergoing total hip arthroplasty (THA). A retrospective cohort study using a large national database identified primary THA patients (2003 to 2023). Patients were one-to-one propensity-matched into NTND (n = 10,503) and non-nicotine user (n = 10,503) groups. Systemic complications (90 days) and prosthesis-related complications (two years) were assessed. The NTND patients exhibited significantly higher rates of systemic complications within 90 days, including sepsis (1.0 versus 0.8%, P = 0.047), deep vein thrombosis (1.9 versus 1.4%, P = 0.01), stroke (0.9 versus 0.6%, P = 0.007), and pneumonia (1.8 versus 1.1%, P < 0.001). Opioid use was significantly higher in NTND patients (88.9 versus 81.5%, P < 0.001). The NTND patients had increased readmission (38.4 versus 33.3%, P < 0.001) and emergency department visit rates (12.1 versus 8.3%, P < 0.001). Prosthesis-related complications at two years were also significantly more common in NTND patients, including periprosthetic joint infection (3.0 versus 2.0%, P < 0.001), prosthetic joint dislocation (1.5 versus 1.2%, P = 0.031), and revision THA (4.0 versus 2.8%, P < 0.001). The NTND patients undergoing THA experience increased medical and surgical complications. As vaping and smokeless nicotine use rise, preoperative screening and cessation strategies should be explored to optimize surgical outcomes.