PURPOSE: While tobacco use has been associated with postoperative surgical complications, its specific impact on postoperative outcomes following partial nephrectomy remains incompletely understood. Therefore, we aim to investigate the association between tobacco use and the incidence and severity of 90-day postoperative complications in patients who underwent partial nephrectomy. MATERIALS AND METHODS: A cross-sectional study was conducted using the Premier Healthcare Database (2010-2019). Our primary outcome was the occurrence of 90-day postoperative complications, classified according to the Dindo-Clavien system. Multinomial logistic regression, adjusted for confounders, estimated the association between tobacco use and the risk of postoperative complications, including 90-day mortality. Predicted probabilities of postoperative complications were calculated from the regression analysis. RESULTS: The study included 44,392 patients (median age 56.3
66.1% males) who underwent elective partial nephrectomy. Among them, 16,048 (36.15%) were tobacco users. Tobacco users were generally younger, less frequently married, predominantly of white ethnicity, and had elevated Charlson Comorbidity Index scores as compared to nonusers. Multinomial logistic regression revealed that tobacco use was significantly associated with increased odds of 90-day postoperative minor complications (OR 1.19, 95% CI 1.14-1.24), major complications (OR 1.41, 95% CI 1.31-1.52), and mortality (OR 1.5, 95% CI 1.01-2.24). CONCLUSIONS: In our cohort, tobacco use significantly increased the risk of minor and major postoperative complications, as well as mortality, in patients undergoing partial nephrectomy. These findings emphasize the importance of tailored preoperative smoking cessation programs to mitigate these risks.