Association Between Non-Tobacco Nicotine Dependence and Postoperative Complications After Ankle and Hindfoot Arthrodesis.

Abstract

Hindfoot and ankle arthrodesis, although routinely performed for arthritis, trauma, and deformity correction, carries risks of several postoperative complications. Cigarette smoking is a well-established risk factor for impaired bone healing, but the effects of non-tobacco nicotine dependence (NTND) are poorly understood. This study aims to evaluate the association between NTND and postoperative complications following ankle and hindfoot fusion. This retrospective cohort study used the TriNetX database to identify patients who underwent hindfoot arthrodesis. Patients were categorized into NTND (<i>International Classification of Diseases, Tenth Revision</i> [<i>ICD-10</i>]: F17, excluding tobacco-specific codes) and nonsmoker cohorts. Propensity score matching (1:1) was performed to balance demographics and comorbidities. Outcomes were assessed at 90 days and 2 years postoperatively from date of surgery using risk ratios (RRs), absolute risk differences, with corresponding 95% CIs. After matching, 2172 patients were included in each cohort. NTND patients had significantly higher 90-day rates of opioid prescriptions (RR 1.20, 95% CI: 1.16-1.24), emergency department visits (RR 1.31, 95% CI: 1.10-1.57), hospitalizations (RR 1.20, 95% CI: 1.07-1.35), postoperative infections (RR 1.61, 95% CI: 1.20-2.17), and wound complications (RR 1.68, 95% CI: 1.26-2.84) (all <i>P</i> < .05). At 2 years, NTND patients experienced increased rates of pseudoarthrosis (RR 1.52, 95% CI: 1.37-1.68), mechanical implant failure (RR 1.42, 95% CI: 1.21-1.67), infection-related implant failure (RR 1.39, 95% CI: 1.12-1.71), and periprosthetic fractures (RR 1.59, 95% CI 1.36-1.87) (all <i>P</i> < .05). No differences in revision arthrodesis rates were observed. NTND is associated with increased short- and long-term complications following hindfoot fusion, suggesting that vaping may negatively impact surgical recovery. Surgeons should incorporate NTND considerations in preoperative risk assessments and promote cessation strategies to optimize patient outcomes.