Impact of Nicotine Replacement Therapy on Breast Surgery Outcomes

Abstract

Background Smoking cessation therapy, including nicotine replacement therapy (NRT), is used perioperatively to assist patients to reduce their tobacco smoke intake and consequently decrease their risk of smoking-associated complications. There are, however, theoretical concerns that nicotine-induced peripheral vasoconstriction could impair wound healing. This study investigated the effect of NRT on postoperative outcomes in patients undergoing breast surgery.

Methods A retrospective chart review of patients undergoing breast surgery within the Yale New Haven Health System from the years 2014 to 2020 was performed. Documented smoking status within 6 months before surgery, use or prescription of NRT, type of surgery, and surgical complications of infection, wound dehiscence, tissue necrosis, hematoma, seroma, fat necrosis, and return to operating room within 30 days were recorded. Demographic and complication data were compared between patients with NRT usage and those without using t-tests and chi-square analyses. Multivariable logistic regression models were created to predict the effect of NRT usage on the occurrence of any complication.

Results A total of 613 breast procedures met inclusion criteria, of which 105 (17.2%) had documented NRT use. The NRT cohort and the non-NRT cohort were well balanced with respect to demographics and procedural variables. Upon multivariable modeling for risk of any surgical complication, NRT was not a significant predictor (odds ratio [OR]: 1.199, p = 0.607 and OR: 0.974, p = 0.912, respectively), whereas procedure type, increased body mass index, and increased age were.

Conclusion NRT use was not associated with an increased risk of postoperative complications compared with not using NRT as part of smoking cessation therapy prior to operation.

Keywords

nicotine replacement therapy - smoking cessation - breast surgery outcomes

• References

• 1 Smoking greatly increases risk of complications after surgery. World Health Organization. Accessed January 20, 2020 at: https://www.who.int/news/item/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery
• 2 Rinker B. The evils of nicotine: an evidence-based guide to smoking and plastic surgery. Ann Plast Surg 2013; 70 (05) 599-605
• 3 Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 2012; 255 (06) 1069-1079
• 4 Hawn MT, Houston TK, Campagna EJ. et al. The attributable risk of smoking on surgical complications. Ann Surg 2011; 254 (06) 914-920
• 5 Bartsch RH, Weiss G, Kästenbauer T. et al. Crucial aspects of smoking in wound healing after breast reduction surgery. J Plast Reconstr Aesthet Surg 2007; 60 (09) 1045-1049
• 6 Krannitz KW, Fong HW, Fallat LM, Kish J. The effect of cigarette smoking on radiographic bone healing after elective foot surgery. J Foot Ankle Surg 2009; 48 (05) 525-527
• 7 Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg 2009; 96 (05) 451-461
• 8 Warner DO, Patten CA, Ames SC, Offord KP, Schroeder DR. Effect of nicotine replacement therapy on stress and smoking behavior in surgical patients. Anesthesiology 2005; 102 (06) 1138-1146
• 9 Forrest CR, Pang CY, Lindsay WK. Dose and time effects of nicotine treatment on the capillary blood flow and viability of random pattern skin flaps in the rat. Br J Plast Surg 1987; 40 (03) 295-299
• 10 Forrest CR, Xu N, Pang CY. Evidence for nicotine-induced skin flap ischemic necrosis in the pig. Can J Physiol Pharmacol 1994; 72 (01) 30-38
• 11 Maa J. A second look at nicotine replacement therapy before surgical procedures. Mayo Clin Proc 2015; 90 (11) 1462-1464
• 12 Lee K, Kruper L, Dieli-Conwright CM, Mortimer JE. The impact of obesity on breast cancer diagnosis and treatment. Curr Oncol Rep 2019; 21 (05) 41
• 13 Lee KT, Mun GH. Effects of obesity on postoperative complications after breast reconstruction using free muscle-sparing transverse rectus abdominis myocutaneous, deep inferior epigastric perforator, and superficial inferior epigastric artery flap: a systematic review and meta-analysis. Ann Plast Surg 2016; 76 (05) 576-584
• 14 Levi B, Rinkinen J, Kidwell KM. et al. Morphomic analysis for preoperative donor site risk assessment in patients undergoing abdominal perforator flap breast reconstruction: a proof of concept study. J Reconstr Microsurg 2014; 30 (09) 635-640
• 15 Fischer JP, Nelson JA, Kovach SJ, Serletti JM, Wu LC, Kanchwala S. Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg 2013; 217 (04) 656-664
• 16 Sørensen LT, Jørgensen S, Petersen LJ. et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res 2009; 152 (02) 224-230
• 17 Prantl L, Moellhoff N, Fritschen UV. et al. Impact of smoking status in free deep inferior epigastric artery perforator flap breast reconstruction: a multicenter study. J Reconstr Microsurg 2020; 36 (09) 694-702
• 18 Ehrl D, Heidekrueger PI, Haas EM. et al. Does cigarette smoking harm microsurgical free flap reconstruction?. J Reconstr Microsurg 2018; 34 (07) 492-498
• 19 Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359 (9301) 114-117
• 20 Lindström D, Sadr Azodi O, Wladis A. et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 2008; 248 (05) 739-745