Urinary tract infection (UTI) at time of geriatric hip fracture surgery increases the risk of experiencing adverse 30-day outcomes

Abstract

Introduction: Pre-operative urinary tract infection (UTI) may be associated with a high rate of complications following surgeries. Few studies have investigated the clinical impact of a pre-operative UTI on post-operative outcomes following surgeries for hip-fracture in geriatric patients. Methods: The 2015e2016 ACS-NSQIP database was queried for patients undergoing hip fracture surgery using CPT-Codes for Total Hip Arthroplasty (27130), Hemiarthroplasty (27125) and Open Reduction/Internal Fixation (ORIF) (27236, 27244, 27245). Only patients 65 years of age undergoing surgery due to a traumatic hip fracture were included in the study. Results: Out of 31,621 patients undergoing surgical treatment for a hip fracture, 410 (1.3%) had UTI at the time of the surgery. Following adjusted logistic regression analysis, UTI present at the time of surgery was associated with a longer length of stay>5 days (OR 5.46 [95% CI 2.27e13.1]; p ¼ 0.008), any complication (OR 1.33 [95% CI 1.49e1.63]; p ¼ 0.007), infectious complications (OR 1.71 [95% CI 1.19 e2.47]; p ¼ 0.004), non-infectious complications (OR 1.28 [95% CI 1.04e1.58]; p ¼ 0.021), 30-day unplanned re-operations (OR 1.96 [95% CI 1.25e3.06]; p ¼ 0.003) and 30-day readmissions (OR 2.04 [95% CI 1.57e2.66]; p < 0.001). With regards to infectious complications, presence of a UTI at time of surgery was a significant independent predictor of sepsis (OR 2.44 [95% CI 1.24e4.80]; p ¼ 0.010) and septic shock (OR 4.05 [95% CI 2.03e8.08]; p < 0.001). Conclusions: Patients undergoing hip-fracture surgery with a concurrent UTI at the time of surgery have more adverse 30-day outcomes as compared to hip fracture patients who do not present with a UTI. Despite adjustment for a delay in the time to surgery, the impact of UTI on post-operative outcomes remained significant. While it is difficult to eradicate a UTI in a non-elective population, the findings stress the need for clinical optimization and potential need for early recognition/management of UTI in patients who sustain a hip fracture to minimize the risk of adverse outcomes.

Osteoporotic hip fracture—Comorbidities and factors associated with in-hospital mortality in the elderly: A nine-year cohort study in Brazil

“…Other infections were also associated with the mortality risk in this population, such as urinary tract infections, which complies with findings of other studies that made this correlation with other complications similar to surgical site infection [18], such as progression to sepsis and extended hospital stay [57].…”

Association of Frailty and the Expanded Operative Stress Score with Preoperative Acute Serious Conditions, Complications, and Mortality in Males Compared to Females

“…NSQIP PATOS variables were associated with increased complications and mortality. [21][22][23][24] However, the literature on preoperative acute conditions is limited with only select conditions studied for targeted surgeries. We found that although males had higher rates and aOR of PASC, males presenting with PASC had lower odds of mortality compared to females with PASC using both subgroup and interaction term analyses across a broad array of surgical types.…”

“…Frailty was assessed by the recalibrated and validated RAI 18,19,29 defining frailty categories as robust ( < 20), normal (20)(21)(22)(23)(24)(25)(26)(27)(28)(29), frail (30)(31)(32)(33)(34)(35)(36)(37)(38)(39), and very frail (≥40). Cases missing any NSQIP variable needed to calculate the RAI were excluded from the analysis (see SDC, http://links.lww.com/SLA/D239).…”

“…However, most studies using NSQIP data do not include PATOS variables. Urinary tract infection, pneumonia, or septic shock PATOS variables were associated with increased postoperative complications and mortality, [21][22][23][24] and other PATOS variables were associated with higher risk of 30-day admissions. 25 However, there is a paucity of data exploring the importance of PATOS variables in postoperative outcomes overall and specific to sex.…”

Risk of Mortality and Readmission among Patients with Pelvic Fracture and Urinary Tract Infection: A Population-Based Cohort Study

“…Infection could affect the healing process by interrupting osteogenesis of osteoblast [ 13 ]. (3) A previous study showed that UTI increased the risk of longer hospitalization, more than 5 days in hip fracture [ 14 ]. However, there were no such data on the risk of adverse outcome of UTIs after pelvic fracture surgery in regards to the importance and necessity of these clinical circumstances.…”