Preoperative Urinary Tract Infection and Perioperative Outcomes After Stress Urinary Incontinence Surgery

INTRODUCTION: A preoperative urinary tract infection (UTI) negatively impacts outcomes after pelvic reconstructive surgery and benign hysterectomy. There is limited understanding of how a preoperative urinary tract infection impacts perioperative outcomes after undergoing isolated surgery for stress urinary incontinence (SUI). OBJECTIVE: We aimed to evaluate the impact of preoperative UTI on 30-day postoperative outcomes on patients undergoing isolated SUI procedures. METHODS: This was a retrospective cohort study using the 2014 to 2023 American College of Surgeons National Surgical Quality Improvement Program database to determine the association between preoperative UTI and perioperative outcomes following SUI surgery. Surgeries included retropubic urethropexy, fascial and synthetic urethral sling, and urethral bulking, which were identified using Current Procedural Terminology codes. Concomitant surgeries aside from cystourethroscopy 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. Any postoperative complication within 30 days of surgery was the primary outcome. Standard group comparisons were performed using the Kruskal–Wallis test for categorical variables and the Wilcoxon test for continuous variables due to data distribution. RESULTS: Twenty-five thousand one hundred thirty-eight patients underwent surgery for SUI: 24,820 (98.7%) urethral slings and 318 (1.3%) retropubic urethropexies. No urethral bulking procedures were included in the dataset. Table 1 displays the patient demographics, clinical characteristics, and SUI surgical outcomes. The median (range) age of the cohort was 52 years (45-63) and body mass index (BMI) was 30.0 kg/m 2 (25.8–34.7). Most women were white (64.7%) with an American Society of Anesthesiologists (ASA) functional class 2 (61.3%). Median operative time was 30 minutes (21–43), and 30-day postoperative complication rate was 1.0% (n=258). The 30-day reoperation and readmission rates were 1.0% and 0.9%, respectively. Eighty-seven (0.3%) patients were diagnosed with a preoperative UTI prior to SUI surgery. Table 1 highlights the significant differences between patients diagnosed with a preoperative UTI and those who did not have a preoperative UTI. Older patients were more likely to have a preoperative UTI (60 years versus 52, p=0.001). Patients diagnosed with a preoperative UTI were more likely to have a higher (class 3 or 4) ASA functional status (36.7% versus 25.4%, p=0.002). The type of SUI surgery performed (p=0.92) and the operative time (32 minutes versus 30, p=0.09) were similar between groups. In patients with a preoperative UTI, the 30-day postoperative complication rate was 2.3% (n=2). This was not statistically different from women who did not have a preoperative UTI (n=256, 1.0%, p=0.17). The postoperative complications within the preoperative UTI cohort included superficial incisional surgical site infection (n=1) and sepsis (n=1). The 30-day reoperation and readmission rates were also similar between groups. CONCLUSIONS: Postoperative complications after SUI surgery were low, and a preoperative UTI was not associated with worse 30-day perioperative outcomes. Surgeons can feel comfortable proceeding with a planned SUI surgery in the setting of an active preoperative UTI since it will not negatively impact 30-day outcomes.Table 1