Impact of Non-Tobacco Nicotine Products on Postoperative Outcomes in Soft Tissue Hand Surgery

Purpose Use of non-tobacco nicotine products (NTNP), including e-cigarettes, nicotine pouches, and oral nicotine devices, has risen sharply, yet their impact on postoperative outcomes across elective soft tissue hand surgeries remains poorly defined. Although nicotine from combustible tobacco impairs wound healing, whether NTNP exposure confers similar risk is unknown. The purpose of this study was to evaluate the association between preoperative NTNP use and postoperative complication rates following elective soft tissue hand surgery. Methods A retrospective cohort study using the TriNetX Research Network identified adults (≥18 years) undergoing elective soft tissue hand surgery from 2004 to 2024. Patients with non-tobacco-specified nicotine dependence diagnoses documented within 1 year before surgery were compared with patients without any documented nicotine dependence. Propensity score matching (1:1) was performed based on demographics and comorbidities. Postoperative complications at 1, 3, and 6 months included deep, superficial, and unspecified surgical site infection, wound dehiscence, and deep vein thrombosis/pulmonary embolism. Odds ratios with 95 percent confidence intervals were calculated, with P < .05 considered statistically significant. Results After matching, 36,811 patients were included per cohort. NTNP use was associated with significantly increased rates of unspecified surgical site infection, deep vein thrombosis/pulmonary embolism, and wound dehiscence at all assessed postoperative time points. Deep and superficial surgical site infection rates did not differ significantly. Effect sizes were consistent across all intervals. Conclusions NTNP use within 1 year is independently associated with higher risks of wound dehiscence, thromboembolic events, and unspecified postoperative infection after soft tissue hand surgery. These findings suggest that nicotine exposure, regardless of delivery method, adversely affects postoperative healing and should be addressed through preoperative screening and cessation counseling. Type of study/level of evidence Retrospective cohort study III.