The burden of tobacco-free nicotine dependence in burn survivors: Acute complications and long-term morbidity.

Abstract

Nicotine use from tobacco-free sources (e.g., electronic cigarettes, oral pouches, and gum) has become prevalent. While tobacco is an established detriment for wound healing, the relationship between tobacco-free nicotine dependence (TFND) and post-burn morbidities has not been defined. This study sought to assess the impact of TFND on short- and long-term complications in burn survivors. A retrospective secondary database cohort study was conducted using electronic health records from multiple health institutions. Patients (18 + years) with burn injury and TFND were identified and compared to burned patients without TFND. Propensity scores were estimated, and 1:1 matching was performed for sociodemographics, comorbidities, burn characteristics, and treatment modalities. Outcomes between matched cohorts included 90-day wound complications and healthcare utilization, with mortality assessed at 90 days and 1 year, as well as new-onset opioid use disorder at 1 year. Statistical significance was set to p < 0.05. Following matching, 20,906 patients were included per cohort. At 90 days, TFND was associated with higher rates of sepsis, wound dehiscence, infection, antimicrobial prescriptions, emergency department visits, and mortality compared with matched controls (all p < 0.05). At 1 year, TFND was associated with elevated rates of mortality and being diagnosed with opioid use disorder (both p < 0.005). Tobacco-free nicotine dependence worsens burn outcomes by increasing the risk of developing wound complications, healthcare utilization, mortality, and opioid use disorder. Routine screening for electronic cigarettes and smokeless nicotine products, paired with early cessation counseling, may enhance survival and burn recovery.