Nicotine replacement during surgical hospitalization not associated with adverse outcomes

An observational study found no difference in complications, mortality, and readmissions between patients who had received nicotine replacement therapy within two days of major surgery and those who hadn't.

Receiving nicotine replacement therapy (NRT) while hospitalized for surgery was not associated with adverse postoperative outcomes, a recent study found.

The retrospective study used data from 552 hospitals to follow 147,506 patients who smoked and underwent a major surgical procedure (with expected stay of two days or more) in 2015 or 2016. Within two days of admission, 17.4% of the patients received NRT. Their characteristics and outcomes in the 30 days following surgery were compared to patients who didn't receive NRT. Results were published by CHEST on Nov. 29.

Patients treated with NRT were younger, less likely to be black or Hispanic, and more likely to have Medicaid coverage than patients who didn't get NRT. Diagnoses of alcohol or substance use disorder and chronic obstructive pulmonary disease were also associated with receipt of NRT. In a propensity-matched analysis, NRT use was not associated with any change in in-hospital complications (odds ratio [OR], 0.99; 95% CI, 0.93 to 1.05), mortality (OR, 0.84; 95% CI, 0.68 to 1.04), all-cause 30-day readmissions (OR, 1.02; 95% CI, 0.97 to 1.07), or 30-day readmissions for wound complications (OR, 0.96; 95% CI, 0.86 to 1.07).

“These results, in a ‘real-world,’ nationally representative sample, using rigorous analytical methods are significant because they reduce the uncertainty around the safety of NRT use in the immediate postoperative period, suggesting that tobacco treatment does not raise the risk of perioperative complications,” the authors said. They noted that the study found fairly low rates of NRT use among surgical patients, as well as variation both by hospital and by procedure.

Although the authors believe this to be the first large observational study of NRT in surgical patients, the results are consistent with previous observational studies and randomized trials in cardiac patients and the general population, they said. Limitations include the possibility of unmeasured confounding and that they weren't able to differentiate between continuation of outpatient NRT and new inpatient prescription or to tell if NRT was continued at discharge.

Continuing smoking cessation services after hospitalization is necessary in order to increase rates of long-term abstinence, the study authors noted. “It is hypothesized that initiation of NRT during a hospitalization may serve as a bridge for lifelong cessation,” they wrote. “Given that hospitalization is a teachable moment with high patient motivation to quit smoking, there appears to be a large opportunity to improve the care of hospitalized patients who undergo surgery and policies should be developed and implemented to support the use of NRT in surgical patients.”