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Smoking is a Significant Risk Factor for Complications following Robotic Assisted Laparoscopic Radical Prostatectomy: A National Surgical Quality Improvement Program (NSQIP) Analysis
Jonathan J. Song, BA1, Maya T. Zhou, BS
1, James McAndrew Jones, III, MD
2, Mark H. Katz, MD
2, David S. Wang, MD
2.
1Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA,
2Boston Medical Center, Boston, MA, USA.
BACKGROUND: For robotic assisted laparoscopic radical prostatectomy (RALP), smoking incurs a higher risk for biochemical recurrence of cancer, though knowledge of smoking’s effect on short-term post-operative complications after RALP is lacking. We assessed the effect of smoking on the rate of 30-day post-operative complications after RALP.
METHODS:We reviewed all reports of RALP as the principal procedure in the ACS NSQIP database from 2012-2022. We sequentially excluded patients with disseminated cancer, pre-operative sepsis, and ventilator dependency. We conducted multivariate logistic regression analyses (adjusting for HTN, COPD, CHF, dialysis, pre-operative UTI, ASA Physical Status Classification, age, BMI, Cr, BUN, and year of surgery) to associations between active smoking (smoking cigarettes in the year prior to surgery) and 30-day post-operative complications (UTI, DVT, PE, sepsis, septic shock, prolonged operation time ≥5hr, prolonged post-operative stay ≥3d, unplanned related reoperation, and death). We report adjusted odds ratios (aOR) and 95% confidence intervals (CI).
RESULTS:We identified 96,410 reports of RALP, of which 10,581 (11.0%) were performed on smokers. In multivariate analysis, smoking was significantly associated with UTI, DVT, sepsis, septic shock, prolonged operation time ≥5hr, prolonged post-operative stay ≥3d, and unplanned related operation (Table 1). Significant risk factors for complications included but were not limited to pre-operative UTI and lower BMI. Smokers underwent reoperation for exploratory laparotomy or laparoscopy (28 [0.3%] vs 126 [0.1%]) and for lysis of adhesions (9 [0.09%] vs 33 [0.03%]) significantly more frequently than non-smokers.
CONCLUSIONS:We found that smoking was a significant risk factor for minor and major 30-day complications following RALP. Encouragement of smoking cessation prior to RALP may reduce post-operative complications.
Univariate and Multivariate Analysis of Association between Smoking and Outcomes | 30-Day Post-Operative Complications | | Non-Smokers, n=85829 (89.0%) | | Smokers, n=10581 (11.0%) | | p-value | | Smoking, aOR (95% CI) |
| Urinary Tract Infection | | 1951 (2.3%) | | 277 (2.6%) | | 0.03 | | 1.21 (1.04-1.40)* |
| Deep Venous Thrombosis | | 595 (0.7%) | | 49 (0.5%) | | <0.01 | | 1.41 (1.04-1.97)* |
| Pulmonary Embolism | | 472 (0.5%) | | 41 (0.4%) | | 0.04 | | 0.76 (0.52)-1.06) |
| Sepsis | | 541 (0.6%) | | 84 (0.8%) | | 0.06 | | 1.30 (1.00-1.66)* |
| Septic Shock | | 107 (0.1%) | | 23 (0.2%) | | 0.02 | | 1.99 (1.17-3.21)* |
| Prolonged Operation Time ≥5hr | | 8094 (9.4%) | | 1219 (11.5%) | | <0.01 | | 1.30 (1.21-1.39)* |
| Prolonged Post-Operative Stay ≥3d | | 7565 (8.8%) | | 1324 (12.5%) | | <0.01 | | 1.48 (1.38-1.59)* |
| Unplanned Related Reoperation | | 798 (0.9%) | | 127 (1.2%) | | <0.01 | | 1.29 (1.04-1.58)* |
| Death | | 95 (0.1%) | | 19 (0.2%) | | 0.07 | | 1.77 (0.98-3.00) |
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