Combustible Tobacco, Smokeless Tobacco, and Cannabis Use in Foot and Ankle Surgery: A Scoping Review of Postoperative Outcomes

Introduction: Tobacco smoking is a known risk factor for adverse surgical outcomes, including delayed wound healing and an increased risk of infection and nonunion. The rising use of cannabis products and alternative nicotine products, such as smokeless tobacco and electronic cigarette devices present new challenges for perioperative management, yet their influence in foot and ankle surgery is not well studied. Objectives: This scoping review aims to synthesize the existing literature on tobacco use, cannabis, and electronic cigarettes and their influence on postoperative outcomes in foot and ankle surgery. Methods: A comprehensive search of PubMed was performed using PRISMA-ScR guidelines. Eligible studies included observational studies and reviews that focus on the relationship between perioperative substance use and foot and ankle surgery complications. Results: There is a wide range of evidence that supports increased wound and bone healing complications with use of combustible tobacco. Data on the effects of smokeless tobacco, electronic cigarettes, and cannabis on this patient population is limited, with most evidence drawn from animal studies or broader orthopaedic literature. Conclusions: The existing data raises potential concern for adverse effects with use of these products. By identifying existing findings and gaps in the literature, this review highlights the need for further research on the perioperative effects of these substances in foot and ankle surgery.