Risk Factors for Postoperative Urinary Tract Infection in Patients Undergoing Arthrodesis for Spinal Deformity of Different Levels.

Abstract

Background: While studies have identified urinary tract infection (UTI) as a complication after spine fusion, UTI is understudied in the context of fusion for spinal deformity. This study sought to determine both UTI incidence after multilevel posterior fusion for spinal deformity and whether pooled risk factors (RFs) increased UTI risk.

Methods: Patients who had posterior fusion for spinal deformities between 2010 to 2019 were queried from the PearlDiver database, separated by the number of levels operated on (<7, 7-12, and >12), matched for age/gender, and analyzed for UTI incidence within 1 week and 1, 2, and 3 months. Any patient with a note of diabetes, obesity, rheumatoid arthritis, or coronary artery disease within 1-year prior to surgery and who contracted UTI within 1 month after fusion was included in the RF group for each level span. Patients of each level span with any RF were compared with those without any RFs. χ ² tests were used for statistical analyses.

Results: A total of 20,893 patients underwent posterior fusion for spinal deformities from 2010 to 2019. After matching, each level set had 2239 patients. At 1, 2, and 3 months, the >12 levels subgroup showed statistically higher UTI incidence than the 7 to 12 and <7 levels subgroups. At 3 months, UTI was similar between the <7 and 7 to 12 subgroups, with 3.8% and 3.9%, respectively (P = 0.41), and UTI was statistically higher in the >12 subgroup at 4.6% (<7 vs 7-12: P = 0.005; <7 vs >12: P < 0.001). For each level group, the RF groups had significantly higher UTI rates at 1, 2, and 3 months. ORs were significantly greater than 1 for RF groups across all level subgroups (<7 OR = 2.8, P < 0.001; 7-12 OR = 2.1, P < 0.001; >12 OR = 2.3, P < 0.001).

Conclusions: Diabetes, obesity, rheumatoid arthritis, and coronary artery disease were associated with a higher risk of UTI after posterior fusion for spinal deformity for all level sets. patients who underwent procedures for more than 12 levels had the highest rate of UTI. This is the first study to analyze and compare UTI incidence following fusion for spinal deformity.

Level of evidence: 3: