Tobacco Use and Non-Tobacco Nicotine Dependence in Operatively Treated Scaphoid Fractures: A Propensity-Matched Cohort Study

Abstract Non-tobacco nicotine dependence (NTND) has become a common alternative to traditional tobacco use. This study aimed to investigate differences in perioperative complications and rates of nonunion among patients with NTND and tobacco use with scaphoid fractures. The TriNetX United States Collaborative Network database was queried using the International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) codes to identify patients aged 18 and older who underwent operatively treated scaphoid fractures between 2010 and 2023. Patients were divided into cohorts depending on their history of NTND. These cohorts were propensity-matched based on age, gender, race, ethnicity, BMI, and type 2 diabetes mellitus. Rates of postoperative complications and nonunion were compared between patients with tobacco use, NTND, and control cohorts. A total of 6,779 patients underwent operative fixation for scaphoid fractures, of which 978 were documented with nicotine dependence. Among these, 651 (66.6%) were nicotine-dependent tobacco users and 327 (33.4%) were NTND. After 1:1 propensity score matching, each cohort included 313 patients. Overall, tobacco users exhibited significantly higher rates of nonunion at 90 days (p = 0.005) and 2 years compared with NTND patients (p = 0.001). There were no significant differences between cohorts in rates of postoperative infection, nonunion repair, avascular necrosis (AVN), emergency department (ED) visits, and rehospitalization. Among NTND patients and the control cohort, NTND patients exhibited higher rates of ED visits (p < 0.0001) and hospitalization (p = 0.012) at 90 days and 2 years. There were no significant differences between rates of nonunion, nonunion repair, four corner fusion (4CF), proximal row carpectomy (PRC), infection, and AVN. Nicotine-dependent tobacco users have significantly higher rates of nonunion following operatively treated scaphoid fractures compared with NTND patients up to 2 years postoperatively. Overall, this study suggests providers should counsel patients with tobacco use preoperatively and consider screening patients prior to operatively managing scaphoid fractures. Retrospective cohort study, level of evidence III.