Back to 2026 ePosters
Nicotine Dependence as a Risk Factor for Complications After Flexor Tendon Repair: A Retrospective Cohort Analysis
Kira L Smith, MD
1, Alexander N Berk, MD
2, Logan Good, MD
2, Rohan Bagchi, BS
3, Kevin J Malone, MD
1; Matthew V Abola, MD
4(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)Hospital for Special Surgery, New York, NY
Introduction: The effects of nicotine on outcomes following flexor tendon repair remain unclear. This study aimed to examine the association between nicotine dependence and the incidence of complications following flexor tendon repair.
Methods: The TriNetX database was queried to identify patients >18 years old who underwent flexor tendon repair. Patients were categorized into two cohorts based on the presence of preoperative nicotine dependence and further stratified based on tobacco versus non-tobacco nicotine dependence (NTND). The cohorts were propensity-matched based on age, gender, race, ethnicity, BMI, and presence of diabetes mellitus. Medical complications were assessed at 90 days, and procedural complications at 90 days and two years.
Results: A total of 20,239 patients undergoing flexor tendon repair were identified, of which 5,645 had a documented history of nicotine dependence. After 1:1 propensity score matching, both cohorts included 5,586 patients. At 90 days, the nicotine-dependent group had significantly higher rates of acute kidney injury (RR 1.67; p=0.033), sepsis (RR 2.30; p=0.023), tenolysis (RR 1.11; p=0.021), ED visits (RR 1.46; p<0.001), and rehospitalization (RR 1.58; p<0.001). At two years, nicotine dependence was associated with higher rates of wound infection (RR 1.49; p=0.002) and joint contracture (RR 0.84; p=0.046). No significant differences were seen in swan-neck deformity, triggering, or re-rupture. NTND patients had lower rates of tenolysis but higher rates of re-rupture and joint contracture compared to tobacco-dependent patients, both at 90 days and at two-year follow-up.
Conclusion: Nicotine dependence is independently associated with an increased risk of both early and delayed postoperative complications.
Back to 2026 ePosters
