To compare post-operative complication rates after robotic-assisted laparoscopic radical prostatectomy (RALP) between smokers and nonsmokers.

We reviewed all reports of RALP as the principal procedure in the American College of Surgeons National Surgical Quality Improvement Program from 2012–2022. We excluded patients with nonmale gender, disseminated cancer, preoperative sepsis, and ventilator dependency. We conducted multivariate logistic regression analyses to assess associations between active smoking (smoking cigarettes in the year prior to surgery) and 30-day post-operative complications, adjusted for various confounders.

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 infectious complications, including superficial surgical site infection (adjusted odds ratio [aOR] 1.43; 95% CI 1.08–1.85), UTI (aOR 1.39; 95% CI 1.10–1.73), and septic shock (aOR 1.76; 95% CI 1.01–2.91) within 30 days. Smokers were also found to have greater odds of surgical complications such as receipt of blood transfusion within 72 h (aOR 1.41; 95% CI 1.07–1.84), prolonged operation time ≥5hr (aOR 1.35; 95% CI 1.21–1.50), and prolonged postoperative stay ≥3d (aOR 1.47; 95% CI 1.32–1.63). Overall, smoking was associated with greater odds of any complication (aOR 1.39; 95% CI 1.28–1.50).

Smoking was a significant risk factor for major 30-day infectious and surgical complications following RALP. While smoking cessation has been previously demonstrated to improve long-term oncologic outcomes after RALP, encouragement of smoking cessation before RALP may reduce immediate post-operative complications.