Arthroscopy - 2026-05-04 - Journal Article
Nontobacco Nicotine Dependence Is Associated With Perioperative Complications and Repeat Surgery After Arthroscopic Rotator Cuff Repair.
Florentino SA, Berk AN, Good LM, Adelstein JM, Wetzel RJ, Ochenjele G, Napora JK
Topics
Key Takeaway
Nontobacco nicotine dependence (NTND) is associated with a 5.8-fold increased odds of repeat rotator cuff repair at 2 years (OR 5.836) and nearly 4-fold increased odds of perioperative MI (OR 3.817) compared to non-nicotine controls.
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Summary
This study asked whether NTND (e-cigarettes, nicotine replacement, etc.) confers different perioperative and medium-term surgical risk than traditional tobacco or no nicotine use after primary arthroscopic rotator cuff repair. Using a large administrative database with 1:1 matching and multivariable logistic regression, NTND patients demonstrated significantly higher 90-day rates of MI (OR 3.817), stroke (OR 2.511), and pneumonia (OR 1.908) versus controls, yet lower ED visits and hospitalizations than tobacco users. At 2 and 5 years, NTND carried higher odds of repeat cuff repair (OR 5.836 at 2 years) and MUA/debridement (OR 1.819) than both comparator groups.
Key Limitation
Administrative database diagnosis codes for NTND lack granularity on product type, nicotine dose, and duration of use, making it impossible to determine whether a dose-response relationship exists or whether cessation prior to surgery mitigates risk.
Original Abstract
PURPOSE
To compare perioperative complications and revision surgery rates between following primary rotator cuff repair among patients with nontobacco nicotine dependence (NTND), no nicotine dependence, and traditional tobacco-related nicotine dependence.
METHODS
A large database was used to identify patients who underwent primary arthroscopic rotator cuff repair from 2003 to 2023 with a minimum of 2-year follow-up. Patients with NTND, traditional tobacco, and non-nicotine use were matched 1:1. Postoperative complications within 90 days and outcomes at 2 and 5 years were compared. Multivariable logistic regression was used to control for confounders.
RESULTS
A total of 6345 NTND patients were matched with 13,398 traditional tobacco users and 80,360 controls. NTND patients had higher 90-day odds of myocardial infarction (odds ratio [OR] 3.817, 95% confidence interval [CI] 1.900-7.668), stroke (OR 2.511, 95% CI 1.452-4.343), pneumonia (OR 1.908, 95% CI 1.225-2.974), emergency department utilization (OR 1.248, 95% CI 1.063-1.464), and hospitalizations (OR 1.659, 95% CI 1.225-2.247) versus nonusers. Compared with tobacco, NTND had lower odds of emergency department visits (OR 0.696, 95% CI 0.607-0.797) and hospitalizations (OR 0.562, 95% CI 0.445-0.709). At 2 years, NTND showed increased odds of subsequent cuff repair (OR 5.836, 95% CI 4.284-7.949) and manipulation under anesthesia or debridement (OR 1.819, 95% CI 1.436-2.304) versus controls. Risks remained significant at 5 years. Compared with tobacco, NTND had significantly higher odds of these procedures at 2 and 5 years. No differences were seen in adhesive capsulitis or total shoulder arthroplasty.
CONCLUSIONS
NTND is associated with increased perioperative complications and secondary manipulation under anesthesia arthroscopic debridement, or arthroscopic rotator cuff repair following primary arthroscopic rotator cuff repair compared with traditional tobacco users and non-nicotine controls.
LEVEL OF EVIDENCE
Level III, retrospective comparative case series.