Reduction in Rates of Symptomatic Urinary Tract Infection After Pelvic Reconstructive Surgery: A Quality Improvement Analysis

Abstract

ImportanceUrinary tract infections contribute to high health care costs.ObjectiveThis study aimed to determine if a combination of interventions was successful at reducing the rate of postoperative symptomatic urinary tract infections (SUTIs) in a female pelvic medicine and reconstructive surgery (FPMRS) practice.Study DesignObservational, retrospective quality improvement analysis looking at the rate of postoperative SUTI within 30 days of surgery in women who underwent gynecologic surgery performed by an FPMRS surgeon from October 2015 to October 2019. Symptomatic urinary tract infection was defined by symptoms and urinalysis, positive urine culture, or treatment for cystitis or urethritis within 30 days of surgery. Interventions were implemented between 2015 and 2016: perioperative cranberry use, intraoperative protocols for catheterization, and postoperative protocols for urinary retention management. In 2018, we added metronidazole to cefazolin for antibiotic prophylaxis. We developed a multivariable logistic regression to determine if postoperative SUTI rates decreased over the study period with adjustment for clustering by surgeons, patient factors, and surgery type.ResultsOf 2,389 procedures performed, 284 (11.8%) involved patients who had an SUTI within 30 days of surgery. The annual infection rate decreased 50% (year 1, 14.7%; year 4, 7.3%). Adjusting for age, race, body mass index, length of stay, surgery type, and surgeon, the odds of SUTI decreased 19% each year (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.72–0.91; P < 0.001). Compared with women who had other gynecologic procedures, those who underwent vaginal prolapse surgery with or without incontinence procedures (OR, 2.75; 95% CI, 1.35–5.54; P = 0.01) or incontinence surgery alone (OR, 2.65; 95% CI, 1.25–5.62; P = 0.01) were more likely to have an SUTI.ConclusionCombining interventions can be highly effective in reducing postoperative SUTI rates.

Improvement Strategies in Surgical Care

“…This supports the use of QI/PI processes for perioperative improvement, although the success rate of projects can be expected to be lower than 88% because of the high probability of publication bias. 4 Duarte Thibault et al 12 presented a surgical QI/PI project that achieved a statistically significant reduction in symptomatic urinary tract infections in urogynecology patients for 4 years (14.7-7.3%; P < 0.0001). They identified a bundle of quality improvement interventions, including perioperative cranberry use, protocols to decrease catheter use, surgeon-specific feedback, and a change in antibiotic prophylaxis.…”