Marczak Tara D, Anand Mallika, Hsieh Yi, Ajayi Ayodele, Hacker Michele R, Winkelman William D
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
Urogynecology (Phila). 2025 Jun 1;31(6):597-603. doi: 10.1097/SPV.0000000000001658. Epub 2025 Jan 29.
Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood.
This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used.
We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use.
Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24).
Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.
吸烟与手术效果不佳有关，这使得许多医生因担心愈合受损而避免在吸烟者中使用诸如网片之类的合成植入物。虽然已经对吸烟者的长期结果进行了研究，但吸烟对术后30天并发症的影响，尤其是与手术网片相关的影响，了解较少。
本研究旨在量化吸烟与微创顶端脱垂修复术后30天内感染、再入院和再次手术风险之间的关联。我们还研究了这些关联是否因是否使用网片而有所不同。
我们使用美国外科医师学会国家外科质量改进计划数据库进行了一项回顾性队列研究，研究对象为2012年至2022年接受微创顶端盆腔器官脱垂修复术的患者。过去一年吸烟为暴露因素。结局包括术后感染、意外再入院和30天内再次手术。我们计算了并发症的调整风险比，并根据网片使用情况对结果进行分层。
在67235例病例中，5518例（8.2%）患者在过去一年吸烟。吸烟者感染和意外再入院的可能性显著更高。吸烟并未增加意外再次手术的风险。吸烟与30天并发症之间的关联不因网片使用情况而有所不同（所有交互作用P值≥0.24）。
吸烟与术后30天内并发症增加有关，尽管绝对风险较低。没有证据表明网片使用会产生影响修饰作用；这表明在接受适当咨询的吸烟者中可以考虑使用网片增强修复术。
