Nontobacco Nicotine Dependence and Rates of Periprosthetic Joint Infection and Other Postoperative Complications in Shoulder Arthroplasty: A Retrospective Analysis

Sep 30, 2024The Journal of the American Academy of Orthopaedic Surgeons

Nicotine Use Without Tobacco Linked to Infection and Other Complications After Shoulder Joint Replacement

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Abstract

Among 89,910 shoulder arthroplasty patients, those with nontobacco nicotine dependence (NTND) showed higher rates of postoperative complications.

Patients with NTND experienced significantly higher rates of sepsis (1.80% vs. 1.20%) and surgical site infections (1.20% vs. 0.70%) within 90 days post-surgery.
Wound disruptions occurred more frequently in the NTND cohort (0.70% vs. 0.40%) during the same timeframe.
Average opioid prescriptions were greater for the NTND group (4.46 vs. 3.34) after surgery.
The NTND cohort had higher readmission rates (10.20% vs. 6.20%) within 90 days.
At the 2-year follow-up, mechanical loosening and prosthetic joint infections were more common in the NTND group (1.10% vs. 0.30% and 2.20% vs. 1.20%, respectively).
No significant difference was found in revision rates between the two cohorts (3.20% vs. 2.90%).

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INTRODUCTION: Nontobacco nicotine products, including e-cigarettes and vaping, are marketed as healthier alternatives to tobacco. However, the literature on nontobacco nicotine dependence (NTND) is scarce. It is important to analyze the influence of these products as they pertain to medical and surgical postoperative complications. This study hypothesizes that patients with NTND will experience more postoperative complications.

METHODS: Using the TriNetX database, which aggregates deidentified medical records from 89 healthcare organizations in the Research Network, Current Procedural Terminology and 10th revision of the International Classification of Diseases codes were used to identify patients undergoing primary shoulder arthroplasty (SA) from January 2012 to February 2024. Patients were divided into cohorts based on their NTND status before surgery. 90-day major medical complications and 2-year implant-related complications were assessed. Statistical analyses involved calculating risk ratios for postoperative complications.

RESULTS: This study analyzed a total of 89,910 SA patients, of which 6,756 were 1:1 propensity matched into NTND or control cohorts. Within the 90-day postoperative period, the NTND cohort exhibited significantly higher rates of sepsis (1.80 vs. 1.20, P = 0.012), surgical site infection (1.20 vs. 0.70%, P = 0.007), and wound disruptions (0.70 vs. 0.40%, P = 0.048), average opioids prescribed (4.46 vs. 3.338, P < 0.001), readmission (10.20% vs. 6.20%, P 0.001) compared with the non-NTND cohort. At the 2-year follow-up, mechanical loosening was notably higher in the NTND group (1.10 vs. 0.30%, P 0.001), as were rates of prosthetic joint infections (2.20 vs. 1.20%, P 0.001). No significant difference was observed for revision rates (3.20% vs. 2.90%, P = 0.269).

DISCUSSION: NTND is associated with higher 90-day rates of wound distruptions, infections, sepsis, as well as increased rates of mechanical loosening and prosthetic joint infection at 2 years postoperatively after SA. These results highlight the need for comprehensive NTND preoperative screening and tailored patient counseling in this patient population.

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Nontobacco Nicotine Dependence and Rates of Periprosthetic Joint Infection and Other Postoperative Complications in Shoulder Arthroplasty: A Retrospective Analysis

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