Nicotine Users Fare Better After Rotator Cuff Surgery Than Smokers

Study finds non-tobacco nicotine products like vapes have fewer postoperative complications compared to traditional cigarettes.

Published on Mar. 4, 2026

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A study presented at the American Academy of Orthopaedic Surgeons annual meeting found that patients who used non-tobacco nicotine products like e-cigarettes had fewer postoperative complications after rotator cuff repair surgery compared to traditional cigarette smokers. The study analyzed medical records data and showed smokers had significantly higher rates of complications like myocardial infarction, acute kidney injury, surgical site infections, and the need for additional procedures. While non-tobacco nicotine users still had some elevated risks compared to non-nicotine users, their outcomes were better than those who smoked cigarettes.

Why it matters

As youth smoking rates have declined but vaping and other non-tobacco nicotine product use has risen, understanding the differential health impacts of these products has become an important public health question. This study provides evidence that, at least for orthopedic surgical outcomes, switching from cigarettes to vapes or other nicotine-only products may offer meaningful health benefits.

The details

Researchers analyzed medical records data on over 40,000 rotator cuff surgery patients, comparing outcomes between non-nicotine users, non-tobacco nicotine users (like vapers), and traditional cigarette smokers. They found smokers had significantly higher rates of serious complications like heart attacks, kidney injury, and surgical site infections compared to non-nicotine users. While non-tobacco nicotine users still had elevated risks in some areas compared to non-users, their outcomes were better than smokers across several key metrics including pneumonia, emergency department visits, and readmissions.

  • The study data was collected over a 90-day postoperative period, except for revision surgery and joint replacement which were tracked for 2 years.
  • The study was presented at the American Academy of Orthopaedic Surgeons annual meeting in March 2026.

The players

Michael L. Moore, MD, MBA

A researcher from the Mayo Clinic in Phoenix, Arizona who led the study.

American Academy of Orthopaedic Surgeons

The professional association that hosted the annual meeting where the study findings were presented.

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What they’re saying

“These findings suggest that, although non-tobacco nicotine products may not be entirely benign, their perioperative risk profile appears to be less severe than that of traditional tobacco use.”

— Michael L. Moore, MD, MBA (medpagetoday.com)

What’s next

Researchers called for prospective studies "to evaluate the long-term clinical implications and underlying mechanisms of nicotine exposure in musculoskeletal healing."

The takeaway

This study adds to growing evidence that switching from traditional cigarettes to non-tobacco nicotine products like vapes may offer meaningful health benefits, at least for certain medical outcomes like orthopedic surgery recovery. However, the healthiest option remains completely avoiding nicotine and tobacco use.