Non-tobacco nicotine dependence increases risk of complications following lumbar spine decompression and fusion

Background

Non-tobacco nicotine products (eg, e-cigarettes, nicotine pouches) are increasingly used by cigarette smokers and prior nonsmokers. While the detrimental effects of cigarette dependence (CD) on healing and surgical recovery are well documented, the impact of non-tobacco nicotine dependence (NTND) on outcomes after lumbar spine surgery remains poorly characterized.

Methods

We conducted a retrospective cohort study using the TriNetX database. Patients undergoing lumbar spine decompression and fusion were divided into 3 cohorts: NTND, CD, and controls (no documented nicotine dependence). Propensity score matching was performed 1:1 based on demographic and clinical characteristics. Complication rates were assessed at 90 days and 3 years postoperatively. Outcomes included anemia, deep vein thrombosis (DVT), myocardial infarction (MI), pneumonia, renal failure, pulmonary embolism (PE), sepsis, stroke, opioid abuse, pseudoarthrosis, and lumbar fracture.

Results

A total of 39,195 matched NTND and control patients were analyzed. NTND was associated with increased 90-day risks of anemia, DVT, MI, pneumonia, renal failure, sepsis, stroke, and opioid abuse, as well as higher 3-year risks of pseudoarthrosis and lumbar fracture (p < .05). In a comparison of 36, 877 matched NTND and CD patients, NTND showed higher anemia risk but lower risks of MI, PE, renal failure, sepsis, stroke, and opioid abuse at 90 days. At 3 years, NTND carried a higher pseudoarthrosis risk but lower lumbar fracture risk relative to CD (p < .0001). When NTND and CD patients were combined (n = 102,720 total), both groups demonstrated significantly higher complications risks compared with controls at both 90 days and 3 years (p < .0001).

Conclusions

NTND is associated with increased perioperative and long-term complications following lumbar spine surgery, including higher rates of infection, opioid abuse, pseudoarthrosis, and lumbar fracture. NTND demonstrates a distinct complication profile compared to CD, underscoring the need for further research on the impact of non-tobacco nicotine exposure on spinal fusion outcomes.