Perioperative nicotine replacement therapy and 30-day outcomes following coronary artery bypass graft surgery: A propensity matched analysis of patients with documented tobacco use

Smoking cessation is important after coronary artery bypass grafting (CABG), but perioperative nicotine replacement therapy (NRT) remains inconsistently used because of concerns regarding wound healing and cardiovascular complications. CABG-specific evidence is limited. We evaluated the association between perioperative NRT exposure and 30-day outcomes among patients with tobacco use undergoing isolated CABG. Patients undergoing isolated CABG (2018-2023) were identified in TriNetX. Perioperative NRT was defined by a medication order or administration record 14 days before though 7 days after surgery. Patients without NRT records were comparators. After propensity matching, 2622 patients were included in each cohort. Mortality was similar (1.79% vs 1.68%; RR 1.07; 95% CI 0.71-1.61; P = 0.75). Major postoperative outcomes were similar. Perioperative NRT exposure was not associated with increased 30-day morbidity or mortality. Because smoking behavior, NRT adherence, formulation, and dose were unavailable, the independent effect of NRT versus nicotine abstinence cannot be determined.