Mihaela S. Stefan, MD

Nicotine replacement therapy is a safe perioperative practice prior to invasive procedures, according to a new observational cohort assessment.

In a retrospective study of 140,000-plus active smokers to have undergone a major surgical procedure, investigators found no added complication risk in those treated with replacement therapy for a nicotine addiction or dependence—particularly for wound healing.

Investigators, led by Mihaela S. Stefan, MD, PhD, associate professor of Medicine at the Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, conducted an analysis to understand the association of nicotine replacement therapy with postoperative outcomes in smokers who have been hospitalized for a surgical procedure.

The assessment was based on the previously held belief that initiating nicotine replacement therapy perioperatively may negatively affect patients’ wound healing.

To gauge the concern, Stefan and colleagues retrospectively assessed 552 hospitals with data of active smokers hospitalized between 2015-2016 for a major surgical procedure—defined as a Medicare Severity Diagnosis-Related Group expected length of stay of ≥2 days. The association of nicotine replacement therapy receipt within 2 days of admission with composite inpatient complication outcomes was analyzed in each patient.

A propensity score for nicotine replacement therapy receipt was developed, and differences in propensity-matched cohort outcomes were examined.

The patient pool included 147,506 active smokers—25,651 (17.4%) of whom were prescribed nicotine replacement therapy within 2 days of admission. On average, treated patients were younger, less likely to be either Black or Hispanic, and more likely to have an alcohol or substance abuse disorder than non-treated patients.

Chronic obstructive pulmonary disease (COPD) and Medicaid were also more common in patients treated with nicotine replacement therapy.

When analyzing for propensity-matched outcomes, investigators found no association between nicotine replacement therapy and in-hospital complications (OR, .99; 95% CI, 0.93 — 1.05); mortality (OR, .84; 95% CI, 0.68 – 1.04); all-cause 30-day readmissions (OR, 1.02; 95% CI, 0.97 – 1.07); or 30-day readmission due to wound complications (OR, 0.96; 95% CI, 0.86 – 1.07).

Stefan and colleagues concluded their findings—the first large observational trial to indicate no association between surgical patients, perioperative nicotine replacement therapy, and adverse outcomes post-procedure—strengthen physicians’ case to routine prescribe the therapy to smokers in the perioperative period of hospitalization.

The study, “The association of nicotine replacement therapy with outcomes among smokers hospitalized for a major surgical procedure,” was published online in CHEST Journal.