Nicotine replacement therapy does not adversely affect surgical outcomes among smokers

Nicotine replacement therapy (NRT) may be safely administered in smokers undergoing a major surgical procedure, with a recent study showing that perioperative NRT does not adversely influence postoperative outcomes.

The study included 147,506 active smokers who had undergone a major surgical procedure (Medicare Severity Diagnosis-Related Group expected length of stay of ≥2 days). Of these, 25,651 patients (17.4 percent) were prescribed NRT within 2 days of admission.

Compared with nontreated patients, those who were treated with NRT were younger, less likely to be Black or Hispanic, more likely to have Medicaid or have a diagnosis of alcohol, substance abuse disorder, or chronic obstructive pulmonary disease.

Propensity matched analysis revealed that receipt of NRT within 2 days of admission was not associated with the following outcomes: in-hospital complications (odds ratio [OR], 0.99, 95 percent confidence interval [CI], 0.93–1.05), mortality (OR, 0.84, 95 percent CI, 0.68–1.04), all-cause 30-day readmissions (OR, 1.02, 95 percent CI, 0.97–1.07) and 30-day readmission for wound complications (OR, 0.96, 95 percent CI, 0.86–1.07).

The current large observational study of surgical patients who actively smoked is the first to demonstrate that perioperative NRT is not associated with adverse outcomes following surgery, researchers said.

The findings should temper concerns regarding the potential negative effect of NRT on wound healing and hence strengthen the evidence that NRT should be prescribed routinely in the perioperative period, they added.