Date of Award

January 2018

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Henry C. Hsia


This study aims to determine the effect of nicotine replacement therapy (NRT) on surgical outcomes such as complication rates in patients undergoing breast surgery. A retrospective chart review of female smokers undergoing breast surgery between January 2014 and April 2017 within the Yale New Haven Health System spanning across four hospitals was performed. Active smoking was defined as cigarette use within one month before or after surgery. A total of 254 patients were identified, 34 of whom had documented NRT use six months within their breast surgery. 52.9% of those with NRT use developed complications—such as infections, wound dehiscence, seromas, hematomas, tissue necrosis, fat necrosis, and lymphedema—compared to 30.5% of their non-NRT counterparts. Multivariate logistic regression using Stata statistical software accounting for covariates including age, BMI, Charlson comorbidity index, insurance type, race, and presence of multiple procedures resulted in a statistically increased risk of complication development in smokers with NRT use [OR 2.42 (1.12-5.25), p=0.027]. Varenicline was not associated with an increased risk, and may be a better alternative in this patient population to reduce their complication risk. In our experience, NRT use by active smokers undergoing breast surgery was associated with an increased risk of postoperative complications compared to those not using NRT. We advise caution regarding prescribing NRT to active smokers in preparation for surgery, and recommend prospective studies to better elucidate the relationship between nicotine use and postoperative outcomes.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100