Evaluating Outcomes in Septorhinoplasty Procedures Using Serum Cotinine as a Measure for Tobacco Use

Objective: Perioperative tobacco use is associated with poor wound healing postoperative complications. The purpose of this study is to use serum cotinine as a measure of tobacco consumption to evaluate complication rates and outcomes in patients undergoing septorhinoplasty procedures. Study Design: Prospective study. Setting: Tertiary care academic center. Methods: Patients >18 years old undergoing septorhinoplasty from December 2017 to January 2023 were included. Serum cotinine levels were obtained on the day of surgery. Preoperative and postoperative nasal obstruction and septoplasty effectiveness (NOSE) scores were assessed. Postoperative wound complications were categorized as mild, moderate, and severe. Chi-square, Fisher exact, and Kruskal-Wallis tests were used to analyze the data. Results: Sixty-seven patients met inclusion criteria. Average age was 46 years, 31 patients were male, and 36 were female. Seven patients reported current tobacco use and 20 reported former use. Thirteen patients (19%) were cotinine-positive, with a median level of 190 ng/mL. None of the cotinine-positive patients had postoperative wound complications, whereas four of the cotinine-negative patients did. There was no significant difference in the change in NOSE scores between the cotinine-positive (−44.0) and cotinine-negative (−45.3) groups (P =.70). Of the cotinine-positive patients, the change in NOSE scores in patients who reported current tobacco use was −33.1 compared to −56.7 in patients who reported former tobacco use (P =.07). Conclusion: Serum cotinine levels can be used for biochemical verification for tobacco use. Reported perioperative tobacco use may not be as predictive for effects on postoperative complications and functional outcomes in patients undergoing septorhinoplasty procedures.