Non-tobacco nicotine products like vapes and nicotine pouches may not be the safer alternative they're marketed as — at least not in the operating room. A new study found that patients using these products faced nearly double the risk of wound complications and infections after Achilles tendon repair, and were even more likely to re-rupture than traditional tobacco users. Surgeons are now being urged to screen for nicotine dependence before operating.
Non-tobacco nicotine products pose serious risks for surgical recovery
A large study presented at the American Orthopaedic Society for Sports Medicine Annual Meeting found that patients using non-tobacco nicotine products — like vapes, e-cigarettes, and nicotine pouches — faced significantly worse outcomes after Achilles tendon repair compared to both non-users and traditional tobacco users. The culprit? Nicotine's vasoconstrictive properties, which impair tissue perfusion, drive immune dysfunction, and increase oxidative stress — all of which hinder post-surgical healing.
The study analyzed over 25,000 patients who underwent primary Achilles tendon repair between 2004 and 2023, using propensity score matching to ensure fair comparisons across groups.
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Why it matters: As vapes and nicotine pouches surge in popularity — especially among young men, who also make up the bulk of Achilles rupture patients — surgeons can no longer treat these products as low-risk alternatives. Preoperative nicotine screening could become a critical step in improving surgical outcomes.
