Incidence, Risk Factors and Outcomes of Urinary Tract Infections among Patients Undergoing Thyroidectomy: Insights from the ACS-NSQIP.

Abstract

Introduction  Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy. Objective  This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy. Methods  This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019. Multivariable logistic regression models were used to identify risk factors and associations of UTIs with postoperative morbidity and mortality. Results  In a cohort of 180,373 identified thyroidectomy patients, 0.28% contracted a UTI. Significant risk factors associated with UTIs included age > 60 years (adjusted odds ratio [OR] 2.187, 95% confidence interval [CI] 1.618-2.956), female gender (OR 1.767, 95% CI 1.372-2.278), American Society of Anesthesiologists (ASA) Classification 3 to 5 (OR 1.463, 95% CI 1.185-1.805), partially (OR 4.267, 95% CI 2.510-7.253) or totally dependent functional health status (OR 9.658, 95% CI 4.170-22.370), pulmonary disease (OR1.907, 95% CI 1.295-2.808), chronic steroid therapy (OR 1.649, 95% CI 1.076-2.527), inpatient procedure (OR 1.507, 95% CI 1.251-1.814), and operative time > 150 minutes (OR 1.449, 95% CI 1.027-2.044). Additionally, UTIs were independently associated with postoperative complications, including pulmonary, vascular, or cardiac complication; stroke; acute renal failure; infectious complications; sepsis; septic shock; pneumonia; prolonged length of stay; unplanned reoperation; and mortality. Conclusion  While UTIs are rare after thyroidectomy, they carry a significant burden on patient outcomes. Preoperative optimization of comorbidities and reducing operative times may help mitigate the risk of UTIs. Optimized care for postoperative UTI patients is also recommended to prevent complications and improve outcomes.