Effects of Non-tobacco Nicotine Dependence on Postoperative Complications Following Cervical Fusion Surgeries

Introduction: Cervical fusion surgeries, including anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCF) and Cervical Corpectomy (CC), are crucial for treating severe cervical spine disorders but carry risks of complications influenced by smoking. While the effects of tobacco on surgical outcomes are well-documented, the impact of non-tobacco nicotine products on postoperative recovery remains underexplored. This study investigates differences in recovery and complications following cervical fusion surgery between non-tobacco nicotine-dependent patients and those without nicotine dependence.

Methods: This retrospective cohort study utilized the TriNetX global health research network to analyze patients who underwent ACDF, PCF, CC procedures. Two cohorts were established: an experimental group of patients with non-tobacco nicotine dependence and a control group without nicotine dependence, identified using ICD-10 codes. Propensity score matching balanced demographic and clinical variables between the groups, and postoperative complications were monitored for 90 days following surgery and 1-year post-operation.

Results: The 90-day and 1-year postoperative analyses showed a consistently higher incidence of complications in the nicotine-dependent (ND) cohort compared to the non-nicotine (NN) cohort following cervical fusion surgery. Within 90 days, patients in the ND group had elevated rates of pseudoarthrosis (21.8% vs. 14.6%), dysphagia (7.5% vs. 5.8%), and dyspnea (5.9% vs. 3.3%), along with increased risks of infection, myocardial infarction (2.1% vs. 1.2%), and stroke. At the 1-year mark, the ND cohort continued to experience higher rates of these complications, including a 25.0% rate of pseudoarthrosis and a 10.0% rate of dysphagia, with notable increases in infection and pneumonia rates. Overall, nicotine dependence is associated with a heightened risk of adverse outcomes that persist over time in cervical fusion patients.

Conclusion : Our findings indicate a significant correlation between non-tobacco nicotine dependence and increased complications, emphasizing the need for clinicians to consider all forms of nicotine use in preoperative assessments. Promoting cessation strategies may enhance surgical outcomes and patient safety as non-tobacco nicotine use rises.