Perioperative Nicotine Use in Orthopedic Surgery Patient

Case at a Glance

A 19-year-old female patient with chronic shoulder pathology scheduled for reconstructive surgery presents with concerns about recent nicotine use despite preoperative cessation instructions.

Patient's Story

The patient is a 19-year-old female (height 157 cm, weight 69 kg) with a 6-year history of chronic shoulder pain requiring surgical reconstruction. She had been a regular nicotine user (vaping) for 5.5 years. Following preoperative instructions, she successfully ceased nicotine use 2-4 weeks prior to her scheduled Friday surgery. However, due to increased stress and discomfort in the days leading up to surgery, she resumed vaping, realizing her mistake only 48 hours before the procedure. She expressed significant anxiety about potential surgery cancellation and questioned whether nicotine would clear her system by the morning of surgery (Wednesday 9 AM to Friday morning timeline).

Initial Assessment

Patient presented with acute anxiety regarding perioperative nicotine exposure and its potential impact on scheduled orthopedic surgery. She demonstrated good compliance with initial cessation instructions but experienced a brief relapse due to preoperative stress.

The Diagnostic Journey

The case required assessment of nicotine's perioperative implications, including wound healing effects, anesthetic considerations, and institutional policies regarding preoperative substance use. Evaluation focused on risk-benefit analysis of proceeding with surgery versus postponement.

Final Diagnosis

Recent nicotine exposure in patient with scheduled orthopedic reconstruction surgery, with concerns about perioperative complications and procedural delays.

Treatment Plan

1. Immediate disclosure to surgical team including surgeon and anesthesiologist 2. Complete cessation of nicotine products 3. Preoperative assessment by anesthesiology team 4. Risk stratification based on timing and extent of exposure 5. Proceed with surgery as scheduled pending team evaluation 6. Enhanced postoperative monitoring for potential complications 7. Smoking cessation counseling and support

Outcome and Follow-up

Medical consultation advised that brief nicotine exposure was unlikely to necessitate surgery cancellation but emphasized the importance of full disclosure to the surgical team. Patient was counseled on the importance of complete cessation and provided with smoking cessation resources. The case highlights the need for comprehensive preoperative counseling that addresses stress management and coping strategies during the cessation period.