The Impact of Smoking on Perioperative Outcomes after Sacrocolpopexy Mesh Removal

Objectives: To investigate the effect of smoking on perioperative outcomes after sacrocolpopexy mesh removal surgery.

Methods: This study is a retrospective cohort study of data obtained from the American College of Surgeons’ National Surgical Quality Improvement Project (ACS-NSQIP) database from 2011 to 2021. Laparoscopic, vaginal, or abdominal sacrocolpopexy mesh removal were defined utilizing current procedural terminology (CPT) (57426, 57295, 57296). Data was analyzed based on procedure performed and tobacco use. Bonferroni correction was used with significance cut off of p-value< 0.002. Demographic, medical, and surgical history, intraoperative, and 30-day perioperative outcomes were compared. Composite perioperative morbidity score was created including variables combining blood transfusion, wound dehiscence, wound infection, reoperation, readmission, pneumonia, sepsis, and VTE.

Results: Overall 74 patients underwent laparoscopic mesh removal, 1,962 underwent vaginal mesh removal, and 124 underwent abdominal mesh removal. For laparoscopic and vaginal mesh removal, smokers were younger than non-smokers (laparoscopic 51±16 vs 65±9.3, p< 0.001; vaginal 52±10 vs 60±12, p< 0.001). Individuals who underwent vaginal mesh removal and smoked tobacco were more likely to have COPD (25(7.7%) vs. 35(2.1%), p< 0.001) and not be Hispanic (17 (6.0%) vs. 190 (13%), p=0.001). There was no difference in wound infection, wound disruption, return to the OR, or composite perioperative morbidity score between smokers and nonsmokers for laparoscopic, vaginal, and abdominal mesh removal. Multivariate analysis was performed which revealed no difference with smoking on composite perioperative morbidity score between smokers and nonsmokers.

Conclusions: Mesh revision surgery after sacrocolpopexy among women who smoke tobacco does not appear to increase 30-day postoperative morbidity. Physicians can reassure their patients who smoke and are undergoing revision surgery for sacrocolpopexy mesh related complications that their recovery appears to be similar to nonsmoking women.