Non-tobacco nicotine dependence (NTND) from products like e-cigarettes and pouches is rapidly rising. Studies have shown that tobacco can negatively impact outcomes following carpal tunnel release (CTR), but literature focusing specifically on NTND is sparse. As such, the purpose of this study was to compare outcomes following CTR between patients with versus without a history of NTND.

The TriNetX database was queried to identify patients over 18 years old who underwent primary CTR. Patients were stratified based on their history of NTND. Cohorts underwent propensity score matching in a 1:1 ratio using demographics, medical comorbidities, and substance use. The following outcomes were collected: 1) post-operative complications, surgical complications, and healthcare utilization within 90 days, 2) opioid use within 2 years, and 3) revision CTR within 2 years.

Within 90 days, patients with NTND ( n  = 9811), compared to those without ( n  = 9811), had significantly higher rates of healthcare utilization, including emergency department visits ( p   <  0.001), and post-operative complications, like pneumonia (OR: 1.372, p  = 0.036) and wound complications (OR: 1.501, p  = 0.005). There were no differences in surgical complications. More patients with NTND were prescribed opioids at all time points within 2 years of CTR (all p   <  0.001). There were no differences in revision surgery rates.

Non-tobacco nicotine dependence is associated with higher rates of healthcare utilization, medical complications, and opioid use following carpal tunnel release. Increased clinical awareness, targeted patient counseling, and pre-operative optimization may be warranted for this growing population.