Impact of Preoperative Urinary Tract Infection on Perioperative Outcomes Following Benign Hysterectomy

INTRODUCTION: Prior studies suggests that preoperative urinary tract infection (UTI) is associated with adverse surgical outcomes in certain patient populations. Literature is limited in patients undergoing gynecologic surgery. OBJECTIVE: To determine the impact of preoperative UTI on 30-day postoperative complications in patients undergoing benign hysterectomy. METHODS: This is a retrospective cohort study using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database to determine the association between preoperative UTI and perioperative outcomes following benign hysterectomy. Surgeries were identified using CPT codes, and surgical indications were classified according to ICD-9 and -10 codes. Gynecologic malignancy risk-reducing indications were categorized as prophylactic. Hysterectomy routes included total abdominal, abdominal supracervical, total laparoscopic, laparoscopic supracervical, laparoscopic assisted vaginal, and vaginal hysterectomies. Robotic and laparoscopic cases are indistinguishable in the database and were grouped together. Surgeries performed for gynecologic malignancies were excluded. 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 Fisher’s exact test for categorical variables and Mann-Whitney U test for continuous variables. A multivariable logistic regression was performed to assess the relationship between preoperative UTI and any 30-day postoperative complication after controlling for potential confounders. Backward selection was performed to include variables with p<0.10 on bivariate analysis. RESULTS: 363,620 patients underwent benign hysterectomy, and 428 (1.2%) met criteria for a preoperative UTI. There were significant differences in demographics, clinical characteristics, and perioperative outcomes between patients diagnosed with a preoperative UTI compared to those without a preoperative UTI (Table 1). 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 preoperative UTI. Vaginal hysterectomy (p<0.001) and surgical indication of pain or prolapse (p<0.001) was higher in the preoperative UTI cohort. Operative time (p<0.001) and reoperation rate (p<0.001) was also higher in the preoperative 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% versus 5.6%, p=0.03). On multivariable logistic regression, preoperative UTI no longer remained associated with any 30-day perioperative complication after benign hysterectomy after controlling for potential confounding variables. However, patients with a preoperative UTI were at almost 4 times higher odds (aOR 3.98) of readmission (Table 2). CONCLUSIONS: While preoperative UTI was not associated with an increased risk of postoperative complication in women undergoing benign hysterectomy, patients with a preoperative UTI ahead of benign hysterectomy were at increased odds of readmission within 30 days. Further research is needed to explore the impact of preoperative UTI on perioperative outcomes, including readmission, after gynecologic surgery.