Nicotine Dependence is Associated with Increased Complications Following Hallux Valgus Correction

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Nicotine dependence has been linked to impaired wound healing and adverse postoperative outcomes in numerous foot and ankle procedures. However, the impact of preoperative nicotine dependence upon postoperative outcomes following hallux valgus correction has not been well described in the literature. This study evaluated short-term and long-term outcomes following hallux valgus correction in patients with and without preoperative diagnoses of nicotine dependence. We employed propensity-matched cohorts to determine whether nicotine dependence is associated with an increase in adverse events at 90 days and 2 years after hallux valgus correction. Methods: We conducted a retrospective analysis using the TriNetX research network, which aggregates deidentified electronic medical records from 105 healthcare organizations. Patients undergoing hallux valgus correction (CPT 28292, 28295-28299) were divided into two cohorts based on the presence (n = 5,913) or absence (n = 51,707) of a prior nicotine dependence diagnosis (ICD-10 F17). Propensity score matching for age, sex, race, and type 2 diabetes mellitus produced 5,913 matched pairs. Primary endpoints included any adverse event and wound dehiscence; endpoints with ≤10 events were excluded. Incidence rates, odds ratios (ORs), and p values were calculated for both 90-day and 2-year time windows. Results: At 90 days, the rate of any adverse event (AAE) was significantly higher in the nicotine-dependent cohort (7.3% vs. 4.0%; p < 0.001). Significant increases were observed for dehiscence (3.5% vs. 1.6%; p < 0.001), acute myocardial infarction (1.5% vs. 0.6%; p = 0.016), SSI (2.2% vs. 1.3%; p < 0.001), emergency department (ED) visits (12.1% vs. 6.2%; p < 0.001), and sepsis (0.5% vs. 0.3%; p = 0.043). No significant differences were found for pulmonary embolism (PE), cerebral infarct, hematoma, or deep vein thrombosis (DVT) at 90 days. At 2 years, the nicotine-dependent group showed a higher composite adverse event rate of 14.6% versus 7.1% (OR 2.06, p < 0.001) with similar significant differences for dehiscence and surgical site infection Conclusion: Nicotine dependence in hallux valgus correction patients was associated with significantly higher rates of any adverse event at both 90 days and 2 years, driven by increased incidences of wound dehiscence, acute myocardial infarction, SSI, ED visits, and sepsis. In contrast, rates of PE, cerebral infarct, hematoma, and DVT did not differ significantly at either time point. These findings suggest that nicotine dependence adversely affects postoperative outcomes following hallux valgus correction. Further prospective studies are warranted to confirm these results and to explore strategies for risk mitigation.