The Association of Nicotine Replacement Therapy With Outcomes Among Smokers Hospitalized for a Major Surgical Procedure

Chest. 2020 May;157(5):1354-1361. doi: 10.1016/j.chest.2019.10.054. Epub 2019 Nov 29.


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.

Keywords: nicotine replacement; smoking; surgery.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Female
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Propensity Score
  • Retrospective Studies
  • Smokers*
  • Smoking Cessation / methods*
  • Surgical Procedures, Operative*
  • Tobacco Use Disorder / therapy*
  • United States
  • Wound Healing*