Non-tobacco nicotine dependence and incidence of pseudarthrosis and other postoperative complications in lumbar fusion surgery: a retrospective analysis.

Abstract

Lumbar fusion is a common procedure to help treat trauma, deformities, tumors, infections, and degenerative diseases of the spine by improving mechanical stability. The rate of non-tobacco nicotine, also known as e-cigarette, use among US adults has recently been increasing. This study seeks to take a collective look at fusion outcomes to address this problem by quantitatively evaluating the effects of non-tobacco nicotine dependence (NTND) on postoperative outcomes following lumbar fusion surgery. A retrospective cohort study using the TriNetX database identified patients undergoing lumbar fusion, categorized into NTND, tobacco-dependent, and non-nicotine users. Propensity score matching (1:1) controlled for demographics and comorbidities. Primary outcomes were 90-day postoperative and 2-year implant-related complications. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Within 90 days, the NTND group had higher rates of pneumonia (RR 1.83; 95% CI 1.24-2.69), renal failure (RR 1.71; 95% CI 1.21-2.42), and sepsis (exclusive to NTND), but lower transfusion rates (RR 0.78; 95% CI: 0.66-0.91) compared to controls. At 2 years, NTND patients had increased pseudarthrosis (RR 1.37; 95% CI 1.09-1.73) and post-laminectomy syndrome (RR 1.36; 95% CI 1.06-1.75), but less adjacent segment disease (RR 0.56; 95% CI: 0.35-0.89). Compared to tobacco users, NTND patients had higher pseudarthrosis (RR 1.59; 95% CI 1.15-2.21), lower adjacent segment disease (RR 0.40; 95% CI 0.22-0.72), and less foot drop (RR 0.54; 95% CI 0.31-0.93). NTND patients experienced higher complication rates following lumbar fusion than non-nicotine users, with continued risks compared to both groups. These findings suggest non-tobacco nicotine may negatively impact surgical outcomes, underscoring the need for preoperative assessment and counseling.