Postoperative complications after hammertoe correction: the influence of tobacco and non-tobacco nicotine

Background: Nicotine use is associated with impaired wound healing and heightened perioperative risks. However, non-tobacco sources such as e-cigarettes and its impact on postoperative complications following hammertoe correction surgery remains underexplored. Purpose: To evaluate the association between nicotine use and postoperative complications after hammertoe correction, comparing outcomes among tobacco-derived nicotine users, non-tobacco nicotine users, and non-nicotine users. Study design: Retrospective cohort study. Methods: A multi-institutional database (TriNetX) was queried to identify adult patients undergoing hammertoe correction. Patients were stratified into three cohorts: (1) nicotine users, (2) non-tobacco nicotine users (e.g., e-cigarette users), and (3) non-nicotine users. Propensity score matching was performed to control for confounders such as age, sex,race, and comorbities. Postoperative complications within 30 days were assessed, including wound disruption, infection, sepsis, deep vein thrombosis (DVT), and pulmonary embolism (PE). Results: Compared to non-nicotine users, both nicotine-exposed cohorts exhibited higher postoperative complication rates. Among tobacco nicotine users, complication rates were: wound disruption (2.7 %), infection (1.7 %), sepsis (0.4 %), DVT (1.1 %), and PE (0.5 %). Non-tobacco nicotine users also demonstrated increased complications: wound disruption (2.3 %), infection (1.7 %), sepsis (0.4 %), DVT (1.2 %), and PE (0.5 %). Conclusion: Nicotine exposure, whether from tobacco or alternative sources, is associated with significantly increased postoperative risks following hammertoe surgery. These findings highlight the importance of preoperative nicotine cessation strategies to reduce surgical complications and improve patient outcomes.