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

BACKGROUND: Non-tobacco 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: The aim of this study was to evaluate the association between preoperative non-tobacco nicotine dependence and the incidence of postoperative complications following abdominoplasty and panniculectomy procedures. METHODS: A retrospective cohort analysis was conducted based on data from the TriNetX Global Collaborative Network. Patients > 18 years who underwent abdominoplasty or panniculectomy were divided into 2 groups: those who had documented non-tobacco nicotine dependence (NTND) and those who had no documented nicotine dependence. Two subanalyses were further conducted, 1 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 3 time intervals: 30 days, 60 days, and 90 days. RESULTS: After 1:1 PSM, each cohort consisted of 1116 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), postoperative 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 postoperatively. Screening for NTND is required during preoperative consultations, and strategies aimed at mitigating the negative effect must be considered. LEVEL OF EVIDENCE: 3: For image description, please refer to the figure legend and surrounding text.