Preoperative Urinary Tract Infection and Perioperative Outcomes After Prolapse Surgery: The National Surgical Quality Improvement Program

INTRODUCTION: Preoperative urinary tract infection (UTI) has been associated with worse 30-day perioperative outcomes in certain surgical specialties. Literature is limited regarding patients undergoing reconstructive pelvic surgery. OBJECTIVE: To evaluate the impact of preoperative UTI on 30-day postoperative complications of patients undergoing prolapse surgery. METHODS: This was a retrospective cohort study using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database to assess the impact of preoperative UTI on perioperative outcomes following prolapse surgery. Patients were identified utilizing preoperative ICD-9 and -10 codes. Patients with a preoperative UTI were compared to patients who did not have a preoperative UTI. Preoperative UTI was defined as any patient with a symptomatic UTI who had not started or was currently receiving antibiotic treatment. Standard group comparisons were performed using Mann-Whitney U and chi-square Fisher’s exact test for continuous and categorical variables, respectively. A multivariable logistic regression was performed to assess perioperative outcomes associated with preoperative UTI. Backward selection was performed to include variables with p<0.10 on bivariate analysis. RESULTS: 86,619 patients underwent prolapse surgery: 273 (0.3%) patients had preoperative UTI. Patients with a preoperative UTI were more likely to be older (69 years versus 63, p<0.001), have a higher body mass index (BMI) (28.6 kg/m2 versus 27.7, p=0.009), and have class 3 or 4 American Society of Anesthesiologists (ASA) class (37.4% versus 26.6%, p<0.001). Reoperation (3.7% versus 1.3%, p=0.004) and readmission (9.5% versus 2.2%, p<0.001) rates were higher in patients with a preoperative UTI. Overall 30-day postoperative complication rate was similar between cohorts (7.0% versus 6.1%, p=0.66). However, when identifying the type of postoperative complication, preoperative UTI was associated with higher likelihood of deep/organ space surgical site infection (2.6% versus 0.5%, p<0.001), perioperative transfusion (2.2% versus 0.7%, p=0.01), and sepsis (2.6% versus 0.2%, p<0.001). On multivariable logistic regression, preoperative UTI was associated with increased odds of both readmission (aOR 4.8) and reoperation (aOR 2.9). CONCLUSIONS: Preoperative UTI was not associated with increased risk of overall 30-day complication rates after prolapse surgery; however, it was associated with increased risk of deep/organ space surgical site infection, perioperative transfusion, and sepsis. Patients with a preoperative UTI were more likely to require readmission and reoperation in the 30 days after surgery. Postponing elective prolapse surgery for patients with a UTI may improve perioperative outcomes (Table 1 and 2).