Impact of preoperative urinary tract infection on perioperative outcomes following benign hysterectomy

Abstract

Introduction

Preoperative urinary tract infection (UTI) is associated with adverse surgical outcomes in certain populations.

Objective

To determine the impact of preoperative UTI on 30-day postoperative complications in patients undergoing benign hysterectomy.

Study Design

A retrospective cohort study using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. Surgeries were identified using CPT codes and surgical indications were classified according to ICD 9 and 10 codes. Preoperative UTI was defined as any patient with a symptomatic UTI who had not started or was currently receiving antibiotic treatment at the time of surgery. The primary outcome was any postoperative complication within 30-days of surgery. Standard group comparisons were performed using Chi −square and Fisher’s exact test for categorical variables and Mann-Whitney U test for continuous variables.

Results

Patients with a preoperative UTI were older (p < 0.001) with higher rates of American Society of Anesthesiologists (ASA) physical status class 3 or 4 (p < 0.001) compared to patients without a UTI. Vaginal hysterectomy (p < 0.001) and surgical indication of pain or prolapse (p < 0.001) was higher in the UTI cohort. Operative time (p < 0.001) and reoperation rate (p < 0.001) was also higher in the UTI cohort. Total 30-day postoperative complications were 5.6 % amongst all patients undergoing benign hysterectomy. Preoperative UTI was associated with a higher 30-day postoperative complication rate compared to patients without a UTI (8.2 % verses 5.6 %, p = 0.03). On multivariable logistic regression, preoperative UTI no longer remained associated with any 30-day perioperative complication after controlling for potential confounding variables. However, patients with a UTI were at almost 4 times higher odds (aOR 3.98) of readmission.

Conclusion

While preoperative UTI was not associated with an increased risk of postoperative complication, patients with a preoperative UTI ahead of benign hysterectomy were at increased odds of readmission within 30 days.