Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty

Abstract

Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon's National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI. Results. 1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6–2.7), chronic steroid use (OR 2.0, 95% CI 1.2–3.2), ages 60–69 (OR 1.5, 95% CI 1.0–2.1), 70–79 (OR 2.0, 95% CI 1.4–2.9), and ≥80 (OR 2.3, 95% CI 1.5–3.6), ASA Classes 3–5 (OR 1.5, 95% CI 1.2–1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3–2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3–2.4). Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement.

Multidrug-Resistant Microorganisms Associated with Urinary Tract Infections Following Orthopaedic Patients: A Laboratory-Based Analysis of 5239 Patients

“…In addition to the catheterization procedure itself, many other factors contribute to the development of UTI, including patient-dependent unmodi able factors, with age that is a particularly strong predictor of UTI. This is con rmed by other authors [1,14] as well as by presented results, which indicate a signi cant, more than 3-fold higher risk of infection in patients aged 75 years and older. One of the conditions may be a generally weaker immune response in older patients, but also a weaker physical condition or limited mobility.…”

“…UTIs are the second most common postoperative complication of patients treated in orthopedic wards, more common than deep venous thrombosis, pneumonia or renal failure [11,1]. The risk of major postoperative complications such as surgical site infections (SSIs) after orthopedic surgery is estimated from 1.4% to over 20%.…”

Indwelling urinary catheter placement and removal practices among surgical patients at Kigali University Teaching Hospital

“…Although the duration of postoperative IUC retention and factors associated with non-immediate removal of the catheter were not explored within the scope of this study, prolonged duration of postoperative IUC was reported in previous studies to be associated with poor outcomes and complications. [34][35][36][37]. This study identified that the IUC removal instructions were not documented in 56.5% only and only 27.3% were recommended to be removed within 24 hours.…”

Indwelling urinary catheter use and associated outcomes among adult patients undergoing surgery

“…[4-8, 11-15, 25] Postoperative UTIs are the 3rd postoperative infections counting 25.9% of bacteraemia, [39] 10% of febrile morbidity, [39] and 0.58% to 11% of symptomatic UTIs. [28,33,34,40,41] An IUC contributes 80%, [42] to 87.8% of postoperative UTIs [41] and postoperative mortality of 0.54% [29] to 10.9%. [34] The most common identified bacteria were Candida albicans (26.6%), Enterobacter cloacae, and Escherichia coli (73.4%).…”