J.Q. Le1, J.M. Tomasko1, A.S. Elnaggar1, P.H. Go1 1Penn State University College Of Medicine, Hershey, PA, USA
Introduction: Smoking has been associated with numerous adverse clinical outcomes after coronary artery bypass graft (CABG) surgery. The use of nicotine replacement therapy (NRT) to promote smoking cessation in the perioperative period is controversial given concerns for wound healing complications and other adverse outcomes. The aim of this study is to evaluate postoperative outcomes associated with the use of NRT in patients undergoing isolated CABG.
Methods: This is a retrospective, database study utilizing the TriNetX Research Network. Patients ≥ 18 years old with a history of tobacco use undergoing isolated CABG were queried from January 2018 to December 2023. Two cohorts were made with or without the use of NRT starting two weeks before to one week after surgery. Propensity score matching for demographics and comorbidities was performed. Postoperative complications occurring within 30 days from surgery were evaluated.
Results: After matching, 5244 total patients were analyzed. The NRT group included 2622 patients (mean [SD] age, 59.9 [9.4] years; 1893 males [72.2%]). The non-NRT group included 2622 patients (59.6 [10.0] years; 1907 males [72.7%]). Pulmonary complications, stroke/TIA, pulmonary embolism, venous thromboembolism/deep vein thrombosis, postoperative kidney failure, cardiac tamponade, cardiac arrest, sepsis, superficial surgical site infection, deep sternal infection, wound dehiscence, wound repair, postoperative re-exploration, and mortality were not significantly different between the two groups.
Conclusion: Perioperative use of NRT in patients undergoing CABG did not increase the incidence of postoperative complications. Specifically, wound complications were unimpacted. NRT utilization in CABG patients may be safe. Additional prospective studies are needed to validate the safety and benefits of NRT in reducing complications following CABG.