Nontobacco Nicotine Dependence as a Risk Factor for Poor Long-Term Outcomes After Shoulder Arthroplasty and Rotator Cuff Repair

INTRODUCTION: Rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA) are common treatments for shoulder osteoarthritis and rotator cuff tears. Although tobacco use is known to worsen surgical outcomes, the effect of nontobacco nicotine dependence (ND) remains unclear. The goal of this study was to evaluate the effects of nontobacco ND on postoperative complications in TSA, rTSA, and RCR. METHODS: A retrospective cohort study using the TriNetX Research Network identified patients undergoing RCR, rTSA, or TSA. Patients with nontobacco ND were compared with those without ND. Propensity score matching balanced demographic factors with outcomes assessed at 1, 2, and 5 years. RESULTS: Prior nontobacco ND was associated with significantly higher rates of mortality, prosthesis dislocation, pneumonia, and sepsis across all surgical groups. The RCR and TSA nontobacco ND cohorts had a significantly higher risk of myocardial infarction than controls. At 2 and 5 years, the nontobacco ND cohorts had a notably higher mortality (up to 80% relative increase in risk) and incidence of mechanical complications than controls. CONCLUSION: Nontobacco ND is a notable risk factor for worse long-term outcomes after TSA, rTSA, and RCR. These findings highlight the need for preoperative counseling and management of ND in patients undergoing shoulder surgery.