Wound Healing Society

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Use Of Nicotine Replacement Therapy In Active Smokers Is Associated With Increased Wound Complication Rates In Breast Surgery
Zhenzhen Xu, Rance Fujiwara, Lisa Fucito, Steven Bernstein, Henry C. Hsia.
Yale University School of Medicine, New Haven, CT, USA.

PURPOSE: Previous studies have demonstrated that tobacco smoking increases the rate of surgical wound complications such as infections and delayed healing. Abstinence can help reduce these risks, but there is controversy if nicotine replacement therapy (NRT) can impact outcomes. This study aims to determine the effect of nicotine replacement therapy (NRT) on rates of healing complications of acute wounds created in patients undergoing breast surgery. METHODS: A retrospective chart review of female smokers undergoing breast surgery between January 2014 and April 2017 within the Yale New Haven Health System spanning across four hospitals was performed. Active smoking was defined as cigarette use within one month before or after surgery. Statistical analyses were performed using Stata software. RESULTS: 254 patients were identified, 34 of whom had documented NRT use six months within their breast surgery. Patient demographics such as BMI, mean age, hospital site of operation, and type of procedure performed were not significantly different between NRT-using smokers and those who did not use NRT, while race, Charlson comorbidity index, and insurance type did vary between the two groups. 52.9% of those with NRT use developed wound complications—such as infections, wound dehiscence, seromas, hematomas, tissue necrosis, fat necrosis, and lymphedema—compared to 30.5% of their non-NRT counterparts. Multivariate logistic regression accounting for covariates including age, race, BMI, Charlson comorbidity index, insurance type, race, and presence of multiple procedures resulted in a statistically significant increased risk of complication development in smokers with NRT use [OR 2.42 (1.10-5.33), p=0.027]. CONCLUSIONS: In our experience, concurrent NRT use in active smokers undergoing breast surgery was associated with an increased risk of postoperative wound complications compared to those not using NRT. We advise caution regarding prescribing NRT to active smokers in preparation for surgery, and recommend prospective studies to better elucidate the relationship between nicotine use and postoperative healing outcomes.


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