Impact of Immunocompromise on Perioperative Outcomes Following Sacrocolpopexy

Objectives: Few data exist on the impact of immunocompromised status on perioperative outcomes in women undergoing sacrocolpopexy. Given the lack of data, the objective of this study was to compare differences in 30-day perioperative morbidity and mortality in immunocompromised versus immunocompetent women undergoing sacrocolpopexy (SCP).

Methods: We conducted a retrospective cross-sectional analysis of female patients aged 18 years or older who underwent SCP from 2012-2017 using data obtained from the American College of Surgeons-National Surgical Quality Improvement Project database. We used current procedural terminology (CPT) procedure codes 57280 and 57425 to identify open and laparoscopic SCP, respectively. The primary exposure was a binary indicator of immunocompromised status, defined as any of the following: steroid use for a chronic condition, chemotherapy for malignancy in within 30 days of operation, radiotherapy for malignancy within 90 days of operation, transfusion >= 1 units packed red blood cells in 72 hours before surgery, currently on dialysis, diabetes mellitus with oral agents or insulin, and smoking within one year of operation. The primary outcome was a composite indicator of readmission, reoperation, or a severe adverse event (e.g., sepsis, cardiac arrest, deep or organ space infection, unplanned intubation) within 30 days after surgery. Log binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI) representing the association between exposure and outcome.

Results: There were 13,525 women who underwent SCP (81% laparoscopic, 19% open) between 2012 and 2017. Of these, 2,628 (19.4%) had an indication of immunocompromised status. The mean age and BMI for the immunocompromised patients were 58.4 ± 12.1 years and 29.5 ± 6.5, respectively. In the immunocompetent women, mean age and BMI were 58.9 ± 11.6 years and 28.0 ± 5.6 respectively. Diabetes and smoking were the most common conditions leading to immunocompromised status. The rate of the composite adverse outcome was 7.3% in immunocompromised women and 4.6% in immunocompetent women. The rates of unplanned readmission and unplanned reoperation were 4.3% and 2.1% in immunocompromised and 2.7% and 1.49% in immunocompetent women, respectively. All other conditions, including severe adverse events, occurred in less than 1% of surgeries. See Table 1. After adjusting for age, body mass index, and surgical approach, immunocompromised women experienced 53% increased risk of an adverse outcome, compared to immunocompetent women (RR=1.53; 95% CI: 1.31, 1.80).

Conclusions: Immunocompromised status, the most common conditions being diabetes and current smoking status, increases the risk of readmission, reoperation, or a severe adverse event within 30 days of surgery compared to immunocompetent individuals undergoing sacrocolpopexy. Our study provides novel data that can help surgeons navigate surgical counseling and informed consent regarding sacrocolpopexy in patients with complex medical conditions.