Impact of Non-Tobacco Nicotine Dependence on Outcomes Following Anterior Lumbar Interbody Fusion

Study Design. Retrospective cohort study Objective. To compare rates of healthcare utilization, complications, opioid use, and revision surgery following anterior lumbar interbody fusion (ALIF) in patients with versus without non-tobacco nicotine dependence (NTND) Summary of Background Data. The prevalence of NTND is rising in the United States due to products such as nicotine e-cigarettes, pouches, gums, and lozenges. Studies have shown that tobacco use can contribute to adverse outcomes following spinal fusion surgery, including pseudarthrosis. However, literature focusing specifically on NTND is sparse. Methods. The TriNetX database was queried to identify patients over 18-years-old who underwent primary ALIF. Patients were stratified into two cohorts based on their history of NTND. Patients underwent propensity score matching in a 1:1 ratio based on demographics and relevant co-morbidities. Covariate balance was confirmed by standardized mean differences ≤ 0.1. The following outcomes were collected: 1) medical complications and healthcare utilization within 90 days, 2) opioid use within 2 years, and 3) surgical complications and revision surgery within 2 years. Results. Within 90 days, patients with NTND (n=2,296), compared to those without (n=2,296), had higher rates of emergency department visits ( P =0.001), outpatient encounters ( P =0.001), pneumonia ( P =0.007), ventilator support ( P =0.019), and sepsis ( P =0.015). Patients with NTND received significantly more opioid prescriptions at all time points (all P ≤0.001). More patients with NTND were prescribed opioids at all time points (all P ≤0.001) except at one week. Lastly, patients with NTND had higher rates of post-laminectomy syndrome (all P <0.001), pseudarthrosis (all P <0.001), and revision surgery (all P <0.05) at all time points within two years. Conclusion. Patients with NTND have higher rates of healthcare utilization, complications, opioid use, and revision surgery following ALIF. Patients should be screened and counseled in a multi-disciplinary fashion to ensure the best possible outcome after surgery. Level of Evidence. IV