Non-Tobacco Nicotine Dependence is Associated With Increased Postoperative Complications Following Abdominoplasty: A Propensity Score-Matched Analysis of a Multi-Institutional Database.

[BACKGROUND] Nontobacco nicotine dependence has been recently linked to the obese population. Although abdominoplasty and panniculectomy are mainly indicated for patients with a history of obesity, no studies have yet investigated whether non-tobacco nicotine dependence poses a risk for abdominoplasty and panniculectomy complications.

[OBJECTIVES] To evaluate the association between preoperative nontobacco nicotine dependence and the incidence of postoperative complications following abdominoplasty and panniculectomy procedures.

[METHODS] A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients > 18 years who underwent abdominoplasty or panniculectomy were divided into two groups: those who had documented nontobacco nicotine dependence (NTND) and those who had no documented nicotine dependence. Two sub-analyses were furtherly conducted, one of patients who underwent abdominoplasty and another of patients who underwent panniculectomy. Propensity score matching (PSM) was applied to balance demographic and clinical variables. Primary outcomes included postoperative complications at three-time intervals: 30 days, 60 days, and 90 days.

[RESULTS] After 1:1 PSM, each cohort consisted of 1,116 patients. Within 90 days following abdominoplasty or panniculectomy, patients with NTND exhibited significantly higher risks of surgical site infection (Relative Risk [RR] 1.458, 95% CI: 1.093,1.945), readmission (RR 1.632, 95% CI: 1.099,2.422), Inpatient hospitalization (RR 1.333, 95% CI: 1.028,1.73), post-operative opioid use (RR 1.281, 95% CI: 1.204,1.363), and any surgical site complications (RR 1.549, 95% CI: 1.287,1.865) compared to patients without nicotine dependence.

[CONCLUSIONS] Non-tobacco nicotine dependence is associated with increased risk of surgical site complications, readmission and opioid consumption within 90 days post-operatively. Screening for NTND is required during pre-operative consultations and strategies aimed at mitigating the negative effect must be considered.