Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery.

OBJECTIVE To report rates and identify risk factors for urinary tract infection (UTI) after hysterectomy for benign conditions or combined with pelvic reconstructive surgery. METHODS This is a cohort study that included women who underwent hysterectomy either for benign gynecologic conditions or hysterectomy combined with pelvic reconstructive surgery from January 1, 2012, through June 30, 2014, at a single institution. The primary outcome was UTI within 8 weeks of surgery. Logistic regression modeling was used to develop a model for predicting UTI after surgery. RESULTS Of 1,156 women included in the study, 136 (11.8%, 95% CI 10.0-13.8) developed UTI within 8 weeks. Women who underwent hysterectomy for a benign gynecologic condition that was not combined with pelvic reconstructive surgery had an overall UTI rate of 7.3% (95% CI 5.6-9.3) vs 21.7% (95% CI 17.6-26.4) after hysterectomy combined with pelvic reconstructive surgery. After adjusting for hormone therapy use, the following were independent variables associated with postoperative UTI: premenopausal status with an adjusted odds ratio (OR) of 1.80 (95% CI 1.11-2.99), anterior vaginal wall prolapse with an adjusted OR of 4.39 (95% CI 2.77-6.97), and postvoid residual greater than 150 mL with an adjusted OR of 2.38 (95% CI 1.12-4.36). Using this model, postoperative UTI rates ranged from 4.3% to 59.4% with high postvoid residual and presence of anterior prolapse having the strongest association. CONCLUSION There are wide variations in the rate of UTI after hysterectomy for begin disease including pelvic reconstructive surgery. These variations can be explained with a model based on available preoperative data.

[1]  J. Jelovsek,et al.  Long-Term Effectiveness of Uterosacral Colpopexy and Minimally Invasive Sacral Colpopexy for Treatment of Pelvic Organ Prolapse , 2017, Female pelvic medicine & reconstructive surgery.

[2]  Anupama Saxena,et al.  Pelvic organ prolapse , 2016 .

[3]  M. Barber,et al.  Apical prolapse repair: weighing the risks and benefits , 2015, Current opinion in obstetrics & gynecology.

[4]  H. Harvie,et al.  Single versus multi-dose antibiotic prophylaxis for pelvic organ prolapse surgery with graft/mesh. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[5]  D. Jenkins,et al.  Is the Centers for Medicare and Medicaid Service's lack of reimbursement for postoperative urinary tract infections in elderly emergency surgery patients justified? , 2014, Surgery.

[6]  H. Mahdi,et al.  Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data. , 2014, Journal of minimally invasive gynecology.

[7]  C. Hollenbeak,et al.  Measuring Surgical Quality: a National Clinical Registry Versus Administrative Claims Data , 2014, Journal of Gastrointestinal Surgery.

[8]  K. Atwa,et al.  Timing of urinary catheter removal after uncomplicated total abdominal hysterectomy: a prospective randomized trial. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[9]  A. Weaver,et al.  Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse , 2014, International Urogynecology Journal.

[10]  N. Siddiqui,et al.  Oral Antibiotics to Prevent Postoperative Urinary Tract Infection: A Randomized Controlled Trial , 2014, Obstetrics and gynecology.

[11]  E. Erekson,et al.  Surgical site infection after hysterectomy. , 2013, American journal of obstetrics and gynecology.

[12]  T. Kuehl,et al.  Incidence and risk factors of postoperative urinary tract infection after uterosacral ligament suspension , 2012, International Urogynecology Journal.

[13]  S. Tennstedt,et al.  Risk factors for urinary tract infection following incontinence surgery , 2011, International Urogynecology Journal.

[14]  P. Hilton,et al.  RCT of urethral versus suprapubic catheterization. , 2010, British journal of nursing.

[15]  Craig A. Umscheid,et al.  Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009 , 2010, Infection Control & Hospital Epidemiology.

[16]  L. Meyn,et al.  Symptomatic urinary tract infections after surgery for prolapse and/or incontinence , 2010, International Urogynecology Journal.

[17]  J. Gebhart,et al.  Hysterectomy and perioperative morbidity in women who have undergone renal transplantation. , 2010, American journal of obstetrics and gynecology.

[18]  Chin-Jung Wang,et al.  Postoperative urinary outcomes in catheterized and non-catheterized patients undergoing laparoscopic-assisted vaginal hysterectomy—a randomized controlled trial , 2009, International Urogynecology Journal.

[19]  Margaret A Dudeck,et al.  CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. , 2008, American journal of infection control.

[20]  H. Wald,et al.  Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. , 2007, JAMA.

[21]  E. Elm,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies , 2007, The Lancet.

[22]  S. Pocock,et al.  Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies , 2007, BMJ : British Medical Journal.

[23]  S. Bai,et al.  Surgical repair of anterior wall vaginal defects , 2007, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[24]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[25]  C. Üstün,et al.  Prophylactic antibiotics in elective abdominal hysterectomy , 2005, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[26]  E. Lukacz,et al.  A randomized, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization. , 2004, American journal of obstetrics and gynecology.

[27]  J. Shlay,et al.  Are in-dwelling catheters necessary for 24 hours after hysterectomy? , 2003, American journal of obstetrics and gynecology.

[28]  T. Dunn,et al.  A comparison of outcomes of transurethral versus suprapubic catheterization after Burch cystourethropexy , 2003, International Urogynecology Journal.

[29]  P. Dwyer,et al.  Recurrent urinary tract infection in the female , 2002, Current opinion in obstetrics & gynecology.

[30]  N. Rojansky,et al.  Prophylactic antibiotics in abdominal hysterectomy. , 1994, Journal of the American College of Surgeons.

[31]  J. Tchabo,et al.  Prophylactic antibiotics in patients undergoing total vaginal or abdominal hysterectomy. , 1985, International surgery.

[32]  T. M. King,et al.  Prophylactic antibiotics in vaginal hysterectomy: a review. , 1982, Obstetrical & gynecological survey.

[33]  F. Hofmeister,et al.  Foley catheter or suprapubic tube? , 1970, American journal of obstetrics and gynecology.

[34]  R. F. Maudsley,et al.  Common Complications of Hysterectomy. , 1965, Canadian Medical Association journal.

[35]  E. S. Pearson,et al.  THE USE OF CONFIDENCE OR FIDUCIAL LIMITS ILLUSTRATED IN THE CASE OF THE BINOMIAL , 1934 .

[36]  N. Fishman,et al.  Healthcare Infection Control Practices Advisory Committee , 2012 .

[37]  R. Chaitow.  Guideline for prevention of catheter-associated urinary tract infections. , 1981, Infection control : IC.