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Tobacco Use and Non-Tobacco Nicotine Dependence in Operatively Treated Scaphoid Fractures: A Propensity-Matched Cohort Study
Kira L Smith, MD
1, Logan Good, MD
2, Alexander N Berk, MD
2, Priya Raju, BS
3, Kevin J Malone, MD
1, Aaron Daluiski, MD
4; Matthew V Abola, MD
5(1)University Hospitals/Case Western Reserve University, Cleveland, OH, (2)University Hospitals Cleveland Medical Center, Cleveland, OH, (3)Case Western Reserve University School of Medicine, Cleveland, OH, (4)Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, (5)Hospital for Special Surgery, New York, NY
Introduction: Non-tobacco nicotine dependence (NTND) has become an increasingly common alternative to traditional tobacco use.This study aimed to investigate differences in perioperative complications and rates of nonunion among patients with NTND and nicotine dependent tobacco use with operatively treated scaphoid fractures.
Methods: The TriNetX US Collaborative Network database was queried using ICD-10 and CPT codes to identify patients aged 18 and older who underwent operatively treated scaphoid fractures between 2010 and 2023. Patients were then divided into two cohorts depending on history of NTND. These cohorts were propensity-matched based on age, gender, race, ethnicity, BMI, and type 2 diabetes mellitus. Rates of postoperative complications and nonunion were compared between patients with tobacco use, NTND, and control cohorts.
Results: A total of 6,779 patients underwent operative fixation for scaphoid fractures, of which 978 were documented with nicotine dependence. Among these, 651 (66.6%) were nicotine dependent tobacco users and 327 (33.4%) were NTND. After 1:1 propensity score matching, each cohort included 313 patients. Overall, nicotine dependent tobacco users exhibited significantly higher rates of nonunion at 90 days postoperatively (p = 0.005). No patients underwent nonunion repair, four corner fusion (4CF), or proximal row carpectomy (PRC) within 90 days. There were no significant differences between cohorts amongst rates of postoperative infection, emergency department (ED) visits, and rehospitalization. At 2 years, nonunion remained significantly elevated in nicotine dependent tobacco users compared to NTND patients (p=0.001). There were no significant differences between cohorts amongst rates of postoperative infection, nonunion repair, AVN, ED visits and rehospitalization. Amongst NTND patients and the control cohort, NTND patients exhibited higher rates of ED visits (p<0.0001) and hospitalization (p=0.012) at 90 days and 2 years. There were no significant differences between rates of nonunion, nonunion repair, 4CF, PRC, infection, and AVN.
Conclusion: Nicotine dependent tobacco users have significantly higher rates of nonunion following operatively treated scaphoid fractures compared to NTND patients up to 2 years postoperatively. Overall, this study suggests providers should counsel patients with tobacco use pre-operatively and consider screening patients prior to operatively managing scaphoid fractures.
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