Nicotine Exposure (Including NRT) and Wound Complications in Plastic Surgery: Single-Institution Cohort, 1992-2024.

Abstract

Plastic-surgery guidance recommends complete preoperative abstinence from all nicotine products. We evaluated whether preoperative nicotine exposure-across delivery methods including e‑cigarettes and NRT-was associated with postoperative wound complications in cosmetic surgery. Single-institution retrospective cohort (July 1992-February 2024). We identified adults undergoing cosmetic procedures, classifying preoperative nicotine status (single delivery method for ≥2 months) and excluding major confounders (e.g., diabetes, peripheral vascular disease, corticosteroids, antineoplastic therapy, BMI>30). Primary outcome was any wound complication. Logistic regression adjusted for age and procedure type. Of 15,172 patients, 1,184 (7.8%) reported nicotine use. Any complication occurred in 15.2% of nicotine users vs 3.8% of non‑users. Adjusted odds of complication were higher for nicotine users (odds ratios across delivery categories 5.51-13.52). Complication profiles were similar across delivery methods; pre-specified head-to-head comparisons among methods were not performed. Preoperative nicotine exposure is associated with substantially higher postoperative wound‑complication risk in cosmetic surgery. Signals were consistent across delivery methods, supporting perioperative counseling that emphasizes complete nicotine abstinence in elective aesthetic procedures.