Nicotine Dependence as a Risk Factor for Complications After Flexor Tendon Repair: A Retrospective Cohort Analysis

Purpose The effects of nicotine on outcomes following flexor tendon repair remain unclear. This study aimed to examine the association between nicotine dependence and the incidence of complications following flexor tendon repair. Methods In this retrospective cohort study, the TriNetX database was queried to identify patients older than 18 years who underwent flexor tendon repair. Patients were categorized into two cohorts based on the presence of preoperative nicotine dependence and further stratified based on tobacco versus nontobacco nicotine dependence. The cohorts were propensity matched based on age, sex, race, ethnicity, body mass index, and presence of diabetes mellitus. Medical complications were assessed at 90 days, and procedural complications were assessed at 90 days and 2 years. Results A total of 20,239 patients undergoing flexor tendon repair were identified, of which 5,645 had a documented history of nicotine dependence. After 1:1 propensity score matching, both cohorts included 5,586 patients. At 90 days, the nicotine-dependent group had statistically significant higher rates of acute kidney injury, adhesion-related complications, emergency department visits, and rehospitalization. At 2 years, nicotine dependence was associated with higher rates of wound infection and lower rates of joint contracture. No statistically significant differences were seen in swan-neck deformity, triggering, or rerupture. Nontobacco nicotine dependence patients had lower rates of adhesion-related complications and higher rates of rerupture than tobacco-dependent patients at both 90 days and 2 years; joint contracture was higher at 90 days but did not differ statistically significant at 2 years. Conclusions Nicotine dependence is independently associated with an increased risk of both early and delayed postoperative complications. Type of study/level of evidence Prognostic III.