(Poster 87) Perioperative Outcomes in Immunocompromised Patients Undergoing Sling Placement

Objectives: Mid-urethral sling with synthetic mesh accounts for the vast majority of anti-incontinence procedures, and rates of mesh complications are low, approximately 2.7-4.4%. The rates of complications in immunocompromised (IC) patients have not been established. We aim to analyze data acquired from the NSQIP database to establish rates of post-surgical complications in IC patients.

Methods: This study analyzed a retrospective cohort of patients who underwent mesh mid-urethral sling placement between 2012 and 2022 using the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database. We used CPT code 57288 indicating midurethral sling and excluded cases where fascia harvest was also performed. Participants were categorized into immunocompromised (IC) and non-immunocompromised (NIC) groups, with IC status defined by the presence of diabetes, smoking, chronic steroid use, recent transfusion, dialysis, or disseminated cancer. Descriptive statistics were calculated for demographic, surgical, and post-operative factors, with comparison between IC and NIC groups. The primary outcome was composite data of readmission, reoperation or serious adverse event (sepsis, cardiac arrest, deep or organ space infection, unplanned intubation) within 30 days after surgery. Chi-square tests of Independence were used to assess differences in post-surgical outcomes between the IC and NIC groups. Unadjusted and adjusted binary logistic regression models were used to assess factors associated with adverse post-operative outcomes. A significance level of p< 0.05 was used for all tests.

Results: 81,137 women were included, with 62,440 (76.9%) in the NIC group and 18,697 (23.1%) in the IC group. Mean age of the study sample was 56.7±13.1 years, participants were predominantly white (72.4%) and non-Hispanic (71.4%), and mean BMI was 30.0±6.4. Within the IC group, the most common qualifying conditions were diabetes (n=9191, 49.2%) and smoking (n=9091,48.6%). Women who were IC were significantly more likely to experience readmission, unplanned reoperation, and many serious adverse events, see Table. The logistic regression model found IC patients to be 13% [OR 1.13; 95%CI 1.08, 1.22; p < .001] more likely to experience any adverse outcomes than their NIC counterparts, after controlling for demographic and other surgical factors.

Conclusions: Our study demonstrates that immunocompromised patients are at significantly higher risk for adverse outcomes. Due to our large sample size, individual statistically significant findings may correlate with minor proportion changes in our sample, and may not be clinically meaningful. However, these findings underscore the importance of considering immunocompromised status when assessing surgical risks and planning interventions for patients undergoing incontinence procedures. Further studies could consider the mechanisms underlying these associations and to develop strategies for mitigating risks in vulnerable patient populations.

Table 1. Sample Descriptives for Post-Surgical Outcomes: Full Sample CPT 57288; Immunocompromised (IC) /Non-Immunocompromised (NIC)