Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Although the negative consequences of tobacco use on surgical outcomes have been well-documented, the role of nicotine replacement therapy (NRT) during the post-operative period remains contested. Some surgeons maintain concern over nicotine’s vasoconstrictive effects and resulting impaired wound healing, especially in free flap reconstruction where patency of the microvascular anastomoses is essential to flap survival. This study aims to evaluate the safety of administering NRT in the post-operative period to head and neck cancer patients who are current smokers and have undergone free flap reconstruction surgery.
Methods: 535 patients who were scheduled to receive free flap reconstruction surgery between August 2020 to October 2024 with the Otolaryngology department at a single surgical center were retrospectively screened for smoking status, oncological history, and NRT administration in the immediate post-operative period. Patients who were identified as current smokers at the time of surgery were categorized as NRT recipients or non-recipients. Post-surgical outcomes were collected and categorized as major surgical complications (flap failure, flap hematoma, or flap revision) and minor surgical complications (wound infection, wound dehiscence, or fistula formation). Other measured outcomes included length of hospitalization following surgery, wound complications, 30-day readmission, and smoking cessation at post-operative follow-up. Outcomes were compared between the two groups, and statistical analysis was conducted using Chi-squared tests for independence and Welsh’s t-test analyses.
Results: A total of 41 patients were included in this study: 11 NRT recipients and 30 non-recipients. Overall, there were no significant differences found between the two groups in patient demographics or post-surgical outcomes. In the NRT recipient group, only three minor complications (27%, one wound dehiscence and two fistulas) and no major complications were reported. In the non-recipient group, six minor complications (20%, including four wound infections and two fistulas) and five major complications (16.7%, including one flap failure, two flap hematomas, two flap revisions) were reported (p=0.94 and p=0.36, respectively). Of note, 20% of NRT recipients reported smoking cessation at subsequent follow-up visits versus 3.3% of non-recipients (p=0.35).
Conclusion: There was no significant difference between major or minor surgical complications between patients who received NRT post-operatively and those who did not. Notably, a higher rate of patients who received NRT reported continued smoking cessation at subsequent follow-up appointments, suggesting that NRT administered in the peri-operative period may play an important role in health outcomes beyond the immediate surgical period. Overall, these findings may indicate that NRT is not associated with increased post-operative risks in free flap reconstruction surgery and may even help patients in smoking cessation efforts during a critical interventional period. Future directions for this project include implementation of a standardized NRT program at multiple surgical centers and evaluation of a larger cohort.