title: Tobacco use as a risk factor for reoperation in patients with stress urinary incontinence: a multi-institutional electronic medical record database analysis.
abstract: OBJECTIVE
  Recurrence rates of stress urinary incontinence after surgery are reported to be between 8 to 15%. Both surgical technique and non-surgical risk factors have been shown to affect post-operative outcomes. Tobacco use is a possible risk factor that may increase the surgical failure rate, however, there are currently conflicting reports in the literature regarding the affect of tobacco use on surgical outcomes. Our objective is to evaluate the effect of tobacco use on the risk of repeat surgery for stress urinary incontinence (SUI).
  
  
  METHODS
  We performed a retrospective cohort analysis using a de-identified clinical database from a large multi-institution electronic health records data web application EPM:ExploreTM (Explorys Inc, Cleveland, Ohio) to identify women with and without a history of tobacco use who underwent reoperation for stress urinary incontinence within 2 years of the first surgery. We then evaluated previously described risk factors for reoperation: diabetes mellitus (DM), pelvic organ prolapse (POP), anti-muscarinic (AM) use at initial surgery, obesity, and advanced age on rate of reoperation and the impact of tobacco use on these risk factors.
  
  
  RESULTS
  Tobacco use was associated with an increased rate of a second surgery for SUI (OR=1.43, p <0.001), as was anti-muscarinic use (OR = 1.68, p<0.001), DM (OR = 1.21, p = 0.005), age >50 years (OR= 1.16, p = 0.040), and BMI > 30 kg/m2 (OR = 2.97 p<0.001). The odds of a second surgery for SUI in patients who used tobacco and anti-muscarinic medications or had pelvic organ prolapse were lower when compared to non-users. The odds of a second surgery for SUI were higher in patients who used tobacco and had asthma when compared to non-users who had asthma.
  
  
  CONCLUSIONS
  Tobacco increases the overall risk of second surgery for SUI, however, in patients with specific risk factors, tobacco use is associated with a decrease risk of reoperation.
authors.affiliation: Division of Female Pelvic Medicine and Reconstruction, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop: 5034, Cleveland, OH, 44106, USA, david.sheyn@uhhospitals.org.
authors.forename: David
authors.initials: D
authors.lastname: Sheyn
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: James
authors.forename: Aisha K
authors.initials: AK
authors.lastname: Taylor
authors.forename: Anne G
authors.initials: AG
authors.lastname: Sammarco
authors.forename: Penny
authors.initials: P
authors.lastname: Benchek
authors.forename: Sangeeta T
authors.initials: ST
authors.lastname: Mahajan
mesh_terms: D057286:Electronic Health Records; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D064424:Tobacco Use / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*