Impact of Non-Tobacco Nicotine Dependence on Postoperative Complications in Lumbar Fusion Surgery

Introduction: Non-tobacco nicotine products, including e-cigarettes and vaping, are marketed as healthier alternatives to tobacco. However, there is currently no literature on non-tobacco nicotine dependence (NTND) and its potential association with complications within 90 days and at 2 years following lumbar fusion surgery. This study aims to assess the relationship between NTND and complications within 90 days and at 2 years following lumbar fusion.

Methods: A retrospective cohort study was conducted using the TriNetX database, identifying lumbar fusion patients. Two cohorts were formed based on NTND status. Propensity score matching (1:1) controlled for demographics and comorbidities between the NTND and control groups. The primary outcomes included 90-day complications (e.g., opioid use, pneumonia, wound complications) and 2-year outcomes (e.g., pseudarthrosis, adjacent segment disease).

Results: Within 90 days postoperatively, the NTND cohort exhibited significantly higher rates of wound complications (RR 1.18), infection (RR 1.27), renal failure (RR 2.14), myocardial infarction (RR 1.75), emergency department visits (RR 1.37), pneumonia (RR 2.11), and complications of surgical care (RR 1.20) compared to controls. At 2 years, NTND patients exhibited significantly higher rates of pseudarthrosis (RR 1.24) and post-laminectomy syndrome (RR 1.35), with a lower incidence of adjacent segment disease (RR 0.81).

Conclusion : NTND is associated with higher rates of complications following lumbar fusion within the first 90 days and up to 2 years post-surgery. These findings indicate that despite being marketed as safer alternatives, non-tobacco nicotine products may negatively impact surgical outcomes and warrant careful consideration in patients undergoing lumbar fusion.