Researchers have established in a new study that the use of nicotine products has been associated with complications in patients who have undergone cervical disc arthroplasty (CDA). This study, based on the US Nationwide Inpatient Sample from 2005 to 2020, evaluated the correlation of nicotine product usage with in-hospital outcomes of adults receiving a primary or a revision CDA. The findings emphasize the potential value of a consideration of preoperative nicotine product use in case selection and for postoperative planning. The study was published in the Journal of Orthopedic Surgery and Research by Yu-Jun Lin and colleagues.
Retrospective analysis was carried out from hospital records of adults (≥18 years) who received CDA. The patients were classified into nicotine product users and non-users. Propensity score matching (PSM) was used to balance baseline features between groups, ensuring proper comparisons. Logistic regression analyses were carried out to determine in-hospital mortality, unfavorable discharge, LOS, and complications, including infections.
Key Findings
• Following 1:1 PSM, a total of 5,562 patients were included in the study. The adjusted analyses showed significant results:
• Nicotine users developed overall complications 37% more (adjusted odds ratio [aOR] = 1.37, 95% confidence interval [CI]: 1.13-1.66, p = 0.002).
• The risk of developing postoperative infections was 74% greater in nicotine users (aOR = 1.74, 95% CI: 1.17-2.58, p = 0.006).
• There was no notable difference in the risk of adverse discharge or length of stay longer than desired among non-users and nicotine users (p > 0.05).
• Male nicotine users had a 112% increased risk of infection (aOR = 2.12, 95% CI: 1.22-3.70, p = 0.008), while there was no such relationship among female patients.
• The risk of infection was especially higher in nicotine users with no diabetes, obesity, or chronic pulmonary disease (p < 0.05).
The study highlights the harmful effect of nicotine consumption on CDA surgical outcomes. The results indicate that nicotine exposure can weaken immune response and tissue repair, resulting in increased complications such as infections. Men seemed to be more susceptible to this risk than women, which might reflect underlying sex-specific physiological variations.
This study concludes that nicotine product use significantly increases the risk of complications, especially infections, in CDA patients. More research is required to investigate the underlying mechanisms and possible interventions to reduce these risks.
Reference:
Lin YJ, Shih FY, Huang JF, Ting CW, Tsai YC, Chang L, Wang HC, Chen WF. Impact of nicotine product use on outcomes of patients receiving cervical disc arthroplasty: a propensity score analysis of the united States nationwide inpatient sample 2005-2020. J Orthop Surg Res. 2025 Mar 19;20(1):298. doi: 10.1186/s13018-025-05700-8. PMID: 40108610; PMCID: PMC11924824.
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