Nontobacco Nicotine Dependence Is Associated With Perioperative Complications and Repeat Surgery After Arthroscopic Rotator Cuff Repair.

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.