Non-tobacco nicotine dependence and rates of perioperative complications in operatively treated unicondylar tibial plateau fractures: A retrospective, propensity-matched cohort analysis.

Abstract

Non-tobacco nicotine dependence (NTND) has become an increasing alternative to traditional tobacco use. However, limited data exists in NTND patients undergoing operative fixation for unicondylar tibial plateau fractures. The purpose of this study was to investigate differences in perioperative complications and mortality among patients with and without NTND undergoing tibial plateau open reduction internal fixation (ORIF). The TriNetX US Collaborative Network database was queried using ICD-10 and CPT codes to identify patients aged 18 and older undergoing unicondylar tibial plateau ORIF between 2004 and 2024. Patients were divided into two cohorts depending on history of NTND. These cohorts were propensity-matched based on age, gender, race, ethnicity, body mass index, and various medical comorbidities. Rates of complications and mortality were compared between cohorts. A total of 99,060,931 patients aged 18 and older were identified, of which 13,589 underwent ORIF for unicondylar tibial plateau fractures. Among these, 12,055 (88.7 %) were non-nicotine users and 1534 (11.3 %) were NTND. After 1:1 propensity score matching, each cohort included 1498 patients. Complications including stroke (OR 1.658), pneumonia (OR 2.036), emergency department (ED) visits (OR 1.536), and death (OR 1.883) were significantly higher in NTND patients 90 days postoperatively (p < 0.05). Furthermore, rates of pneumonia (OR 1.733), osteomyelitis (OR 3.456), and ED visits (OR 1.798) were significantly elevated in the NTND cohort compared to their counterparts 1 year postoperatively (p < 0.05). NTND patients have higher rates of mortality and numerous postoperative complications including stroke, pneumonia, osteomyelitis, ED visits, and death following tibial plateau ORIF. Overall, this study suggests providers should counsel patients with NTND pre-operatively and consider screening patients prior to operatively managing unicondylar tibial plateau fractures. Retrospective cohort study; Level of evidence III.