Mihaela S Stefan1, Quinn Pack2, Meng-Shiou Shieh3, Penelope S Pekow4, Steven L Bernstein5, Karthik Raghunathan6, Katie S Nason7, Peter K Lindenauer8. 1. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA; Department of Medicine, Yale School of Medicine, New Haven, CT. Electronic address: mihaela.stefan@baystatehealth.org. 2. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA; Department of Medicine, Yale School of Medicine, New Haven, CT. 3. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA. 4. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA; School of Public Health and Health Sciences, Yale School of Medicine, New Haven, CT. 5. Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT. 6. Division of Veterans Affairs, Department of Anesthesiology, Duke University Medical Center, Durham, NC. 7. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA; Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA; Department of Surgery, University of Pittsburgh, Pittsburg, PA. 8. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA; Department of Medicine, Yale School of Medicine, New Haven, CT; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
Abstract
BACKGROUND: There are concerns that starting nicotine replacement therapy (NRT) in the immediate perioperative period may negatively impact wound healing. We investigated the association of NRT with postoperative outcomes among smokers hospitalized for a surgical procedure. METHODS: This was a retrospective study in 552 hospitals of active smokers hospitalized between January 1, 2015 and December 31, 2016 for a major surgical procedure (Medicare Severity Diagnosis-Related Group expected length of stay, ≥ 2 days). We analyzed the association of receipt of NRT within 2 days of admission with a composite outcome of inpatient complications and with other outcomes. We developed a propensity score for receipt of NRT and examined differences in outcomes in a propensity-matched cohort. RESULTS: Of 147,506 active smokers, 25,651 (17.4%) were prescribed NRT within 2 days of admission. Patients treated with NRT were younger; less likely to be black or Hispanic; more likely to have Medicaid; and more likely to have a diagnosis of alcohol or other substance use disorder, or COPD, compared with those who were not treated. In the propensity-matched analysis, there was no association between receipt of NRT and in-hospital complications (OR, 0.99; 95% CI, 0.93-1.05), mortality (OR, 0.84; 95% CI, 0.68-1.04), all-cause 30-day readmissions (OR, 1.02; 95% CI, 0.97-1.07), or 30-day readmission for wound complications (OR, 0.96; 95% CI, 0.86-1.07). CONCLUSIONS: This is the first large observational study of surgical patients to demonstrate that perioperative NRT is not associated with adverse outcomes after surgery. These results strengthen the evidence that NRT should be prescribed routinely in the perioperative period.
BACKGROUND: There are concerns that starting nicotine replacement therapy (NRT) in the immediate perioperative period may negatively impact wound healing. We investigated the association of NRT with postoperative outcomes among smokers hospitalized for a surgical procedure. METHODS: This was a retrospective study in 552 hospitals of active smokers hospitalized between January 1, 2015 and December 31, 2016 for a major surgical procedure (Medicare Severity Diagnosis-Related Group expected length of stay, ≥ 2 days). We analyzed the association of receipt of NRT within 2 days of admission with a composite outcome of inpatient complications and with other outcomes. We developed a propensity score for receipt of NRT and examined differences in outcomes in a propensity-matched cohort. RESULTS: Of 147,506 active smokers, 25,651 (17.4%) were prescribed NRT within 2 days of admission. Patients treated with NRT were younger; less likely to be black or Hispanic; more likely to have Medicaid; and more likely to have a diagnosis of alcohol or other substance use disorder, or COPD, compared with those who were not treated. In the propensity-matched analysis, there was no association between receipt of NRT and in-hospital complications (OR, 0.99; 95% CI, 0.93-1.05), mortality (OR, 0.84; 95% CI, 0.68-1.04), all-cause 30-day readmissions (OR, 1.02; 95% CI, 0.97-1.07), or 30-day readmission for wound complications (OR, 0.96; 95% CI, 0.86-1.07). CONCLUSIONS: This is the first large observational study of surgical patients to demonstrate that perioperative NRT is not associated with adverse outcomes after surgery. These results strengthen the evidence that NRT should be prescribed routinely in the perioperative period.
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