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The Impact of Nicotine Dependence on Postoperative Complications following Humeral Shaft Fracture Repair
Journal article   Peer reviewed

The Impact of Nicotine Dependence on Postoperative Complications following Humeral Shaft Fracture Repair

Kimberly Dong, Daniel Davis and Asif M. Ilyas
JSES reviews, reports, and techniques, p100732
Mar 2026
DOI: https://doi.org/10.1016/j.xrrt.2026.100732
url
https://doi.org/10.1016/j.xrrt.2026.100732View
Published, Version of Record (VoR) Open

Abstract

fracture humeral shaft humerus Nicotine nicotine dependence orthopaedic surgery orthopaedics
Humeral shaft fractures account for approximately 3% of orthopedic injuries each year. While the standard treatment is nonoperative management, surgery is performed in cases where fixation is required to restore alignment and optimize healing. The success of these procedures depends on a number of factors, including fracture characteristics, intraoperative fixation, and patient characteristics. This study was undertaken to better understand the effect of nicotine dependence on surgical outcomes following humeral shaft fracture surgical management. The study hypothesis was that complications and reoperations would be higher in patients with nicotine dependence undergoing humeral shaft fracture repair. The TriNetX US Collaborative Network was queried for all adult patients diagnosed with a humeral shaft fracture undergoing either fixation via a plate and screw construct or intramedullary fixation between 2005 and 2025. Cohorts were defined by inclusion or exclusion of the ICD code for nicotine dependence prior to surgery. Statistical analysis was performed after propensity score matching to determine differences in postoperative outcomes between cohorts. We looked at incidence of PE, upper extremity DVT, postoperative infection, sepsis, and disruption of wound up to 90 days postop, and incidence of post operative infection, nonunion and reoperation between 3 months and 1 year postop. The risk ratio was significantly elevated for those with nicotine dependence for a number of outcomes: 1.630 (1.213, 2.190) for postoperative early infection, 1.645 (1.102, 2.455) for disruption of wound, 1.822 (1.194, 2.780) for late infection, 1.907 (1.364, 2.668) for nonunion, and 1.810 (1.246, 2.628) for reoperation. No significant differences in risk were found between cohorts for pulmonary embolism, upper extremity deep vein thrombosis, or sepsis. Nicotine dependence prior to surgical fixation of humeral shaft fractures is associated with a 60-110% increased risk for surgical complications including postoperative infection, wound disruption, nonunion and reoperation. These findings emphasize the importance of preoperative risk stratification and advising smoking cessation in order to optimize surgical outcomes for this patient population.

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