Non-Tobacco Nicotine Dependence Is Associated With Increased Postoperative Risk for Intramedullary Nailing of Intertrochanteric Fractures: A Propensity-Matched Analysis

Nicotine use is known to increase postoperative complications; however, studies show that the general population believes non-tobacco nicotine usage is a safer option compared to tobacco-based nicotine products. This study evaluates postoperative complications between non-tobacco nicotine-dependent and non-nicotine-dependent patients for intramedullary nailing in intertrochanteric femur fractures. In this retrospective cohort study, we used the TriNetX database to evaluate postoperative outcomes in patients ages 40 to 90 who underwent intramedullary nailing for an intertrochanteric femur from May 18th, 2003, to May 18th, 2023. Two cohorts were analyzed. Cohort A were nicotine-dependent patients who did not use tobacco products (e.g., cigarettes or chewing tobacco). Cohort B were patients that did not have a dependence to any form of nicotine. Cohorts were propensity matched for body mass index, type 2 diabetes mellitus, alcohol-related disorders, and demographic factors, such as age at event, ethnicity, race, and sex. The outcomes evaluated were deceased, sepsis, deep vein thrombosis, pneumonia, muscle atrophy, cutaneous infection, acute postoperative pain, revision, wound disruption, pulmonary embolism, and nonunion. All postoperative complications were analyzed between 1 day and 6 months after treatment. A total of 1,834 non-tobacco nicotine-dependent patients were matched with 20,123 non-nicotine-dependent patients. Nicotine-dependent patients experienced higher associated risk for numerous postoperative complications and, when compared to non-nicotine-dependent patients, had increased risk for death within 6 months postoperatively (11.3% vs 8.0%, P = 0.0008), sepsis (5.8% vs 4.3%, P = 0.0416), and pneumonia (10.1% vs 6.1%, P < 0.0001). Non-tobacco nicotine dependence increases postoperative complications for patients undergoing intramedullary nailing for an intertrochanteric fracture. Our findings support the development of perioperative nicotine cessation guidelines.