Joshua Wang, Brandon N Cambre, Daniel H Cho, Annie L M Dugan, Vishank Panchbhavi, Allen S Wang, Vinod K Panchbhavi
{"title":"尼古丁依赖对皮隆骨折切开复位内固定术后疗效的影响：一项比较队列分析。","authors":"Joshua Wang, Brandon N Cambre, Daniel H Cho, Annie L M Dugan, Vishank Panchbhavi, Allen S Wang, Vinod K Panchbhavi","doi":"10.1097/BOT.0000000000003085","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To examine postoperative complication rates in patients with nicotine dependence compared to non-users to clarify the risks in pilon fracture recovery.</p><p><strong>Methods: </strong>Design: Retrospective cohort analysis.</p><p><strong>Setting: </strong>Data from the TriNetX Health Research Network.</p><p><strong>Patient selection criteria: </strong>Patients aged 18 years or older who underwent open reduction internal fixation (ORIF) for OTA/AO type 43 pilon fractures between 2000 and 2022 were categorized into nicotine-dependent and non-dependent groups.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included rates of malunion, nonunion, mechanical complications such as internal fixation failure or removal, and need for revision surgery by 2-year follow-up. Secondary outcomes over a 90-day period included wound disruption, infection, sepsis, and thrombotic events. Statistical analysis calculated risk ratios and odds ratios, with significance set at P < 0.05.</p><p><strong>Results: </strong>After propensity score matching (N = 4,371 patients in each cohort), the mean age was 44.4 ± 14.5 years in Cohort 1 and 44.7 ± 15.7 years in Cohort 2. Female patients comprised 34.9% of Cohort 1 and 35.3% of Cohort 2. Nicotine dependence was associated with increased risks of mechanical complications (5.8% vs. 4.4%; P = 0.003), malunion/nonunion (6.3% vs. 4.7%; P = 0.002), wound disruption (4.5% vs. 3.2%; P = 0.002), and a higher infection rate (5.7% vs. 3.7%; P < 0.001). Conversely, the incidence of pulmonary embolism was lower in nicotine users (0.3% vs. 0.7%; P = 0.005).</p><p><strong>Conclusion: </strong>Nicotine dependence showed significantly elevated risk of adverse postoperative outcomes in pilon fracture surgeries, including mechanical failure, wound complications, and infection. However, the incidence of pulmonary embolism was lower among nicotine users. These results underscored an association between preoperative nicotine dependence and postoperative complications.</p><p><strong>Level of evidence: </strong>Level III, Prognostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Nicotine Dependence on Postoperative Outcomes in Pilon Fracture Open Reduction and Internal Fixation: A Comparative Cohort Analysis.\",\"authors\":\"Joshua Wang, Brandon N Cambre, Daniel H Cho, Annie L M Dugan, Vishank Panchbhavi, Allen S Wang, Vinod K Panchbhavi\",\"doi\":\"10.1097/BOT.0000000000003085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To examine postoperative complication rates in patients with nicotine dependence compared to non-users to clarify the risks in pilon fracture recovery.</p><p><strong>Methods: </strong>Design: Retrospective cohort analysis.</p><p><strong>Setting: </strong>Data from the TriNetX Health Research Network.</p><p><strong>Patient selection criteria: </strong>Patients aged 18 years or older who underwent open reduction internal fixation (ORIF) for OTA/AO type 43 pilon fractures between 2000 and 2022 were categorized into nicotine-dependent and non-dependent groups.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included rates of malunion, nonunion, mechanical complications such as internal fixation failure or removal, and need for revision surgery by 2-year follow-up. Secondary outcomes over a 90-day period included wound disruption, infection, sepsis, and thrombotic events. Statistical analysis calculated risk ratios and odds ratios, with significance set at P < 0.05.</p><p><strong>Results: </strong>After propensity score matching (N = 4,371 patients in each cohort), the mean age was 44.4 ± 14.5 years in Cohort 1 and 44.7 ± 15.7 years in Cohort 2. Female patients comprised 34.9% of Cohort 1 and 35.3% of Cohort 2. Nicotine dependence was associated with increased risks of mechanical complications (5.8% vs. 4.4%; P = 0.003), malunion/nonunion (6.3% vs. 4.7%; P = 0.002), wound disruption (4.5% vs. 3.2%; P = 0.002), and a higher infection rate (5.7% vs. 3.7%; P < 0.001). Conversely, the incidence of pulmonary embolism was lower in nicotine users (0.3% vs. 0.7%; P = 0.005).</p><p><strong>Conclusion: </strong>Nicotine dependence showed significantly elevated risk of adverse postoperative outcomes in pilon fracture surgeries, including mechanical failure, wound complications, and infection. However, the incidence of pulmonary embolism was lower among nicotine users. These results underscored an association between preoperative nicotine dependence and postoperative complications.</p><p><strong>Level of evidence: </strong>Level III, Prognostic.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BOT.0000000000003085\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000003085","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较尼古丁依赖患者与非尼古丁依赖患者的术后并发症发生率，以明确头枕骨折恢复的风险。方法：设计：回顾性队列分析。环境：数据来自TriNetX卫生研究网络。患者选择标准：2000年至2022年期间接受开放性复位内固定（ORIF）治疗OTA/AO型43匹隆骨折的18岁及以上患者分为尼古丁依赖组和非尼古丁依赖组。结果测量和比较：主要结果包括不愈合、不愈合、机械并发症（如内固定失败或取出）的发生率，以及2年随访时是否需要翻修手术。90天期间的次要结局包括伤口破裂、感染、败血症和血栓事件。统计分析计算风险比和优势比，P < 0.05为显著性。结果：经过倾向评分匹配（每组4371例），队列1的平均年龄为44.4±14.5岁，队列2的平均年龄为44.7±15.7岁。女性患者在队列1中占34.9%，在队列2中占35.3%。尼古丁依赖与机械并发症（5.8% vs. 4.4%, P = 0.003）、不愈合/不愈合（6.3% vs. 4.7%, P = 0.002）、伤口破裂（4.5% vs. 3.2%, P = 0.002）和较高的感染率（5.7% vs. 3.7%, P < 0.001）相关。相反，尼古丁使用者的肺栓塞发生率较低（0.3%对0.7%;P = 0.005）。结论：尼古丁依赖显著增加了枕部骨折手术后不良结局的风险，包括机械故障、伤口并发症和感染。然而，在尼古丁使用者中，肺栓塞的发生率较低。这些结果强调了术前尼古丁依赖与术后并发症之间的关联。证据等级：III级，预后。
Impact of Nicotine Dependence on Postoperative Outcomes in Pilon Fracture Open Reduction and Internal Fixation: A Comparative Cohort Analysis.
Objectives: To examine postoperative complication rates in patients with nicotine dependence compared to non-users to clarify the risks in pilon fracture recovery.
Methods: Design: Retrospective cohort analysis.
Setting: Data from the TriNetX Health Research Network.
Patient selection criteria: Patients aged 18 years or older who underwent open reduction internal fixation (ORIF) for OTA/AO type 43 pilon fractures between 2000 and 2022 were categorized into nicotine-dependent and non-dependent groups.
Outcome measures and comparisons: Primary outcomes included rates of malunion, nonunion, mechanical complications such as internal fixation failure or removal, and need for revision surgery by 2-year follow-up. Secondary outcomes over a 90-day period included wound disruption, infection, sepsis, and thrombotic events. Statistical analysis calculated risk ratios and odds ratios, with significance set at P < 0.05.
Results: After propensity score matching (N = 4,371 patients in each cohort), the mean age was 44.4 ± 14.5 years in Cohort 1 and 44.7 ± 15.7 years in Cohort 2. Female patients comprised 34.9% of Cohort 1 and 35.3% of Cohort 2. Nicotine dependence was associated with increased risks of mechanical complications (5.8% vs. 4.4%; P = 0.003), malunion/nonunion (6.3% vs. 4.7%; P = 0.002), wound disruption (4.5% vs. 3.2%; P = 0.002), and a higher infection rate (5.7% vs. 3.7%; P < 0.001). Conversely, the incidence of pulmonary embolism was lower in nicotine users (0.3% vs. 0.7%; P = 0.005).
Conclusion: Nicotine dependence showed significantly elevated risk of adverse postoperative outcomes in pilon fracture surgeries, including mechanical failure, wound complications, and infection. However, the incidence of pulmonary embolism was lower among nicotine users. These results underscored an association between preoperative nicotine dependence and postoperative complications.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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