Division of Urology, Department of Surgery, Ottawa Hospital, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada.
J Urol. 2017 May;197(5):1268-1273. doi: 10.1016/j.juro.2016.12.093. Epub 2016 Dec 27.
Mid urethral sling surgery is common. Postoperative urinary tract infection rates vary in the literature and independent risk factors for urinary tract infection are not well defined. We sought to determine the incidence of and risk factors for urinary tract infection following mid urethral sling surgery.
A retrospective cohort of females who underwent sling surgery was captured from the 2006 to 2014 NSQIP® (National Surgical Quality Improvement Program®) database. Exclusion criteria included male gender, nonelective surgery, totally dependent functional status, preoperative infection, prior surgery within 30 days, ASA® (American Society of Anesthesiologists®) Physical Status Classification 4 or greater, concomitant procedure and operative time greater than 60 minutes. The primary outcome was the incidence of urinary tract infection within 30 days of mid urethral sling surgery. Risk factors for urinary tract infection were assessed by examining patient demographic, comorbidity and surgical variables. Logistic regression analyses were performed to estimate the ORs of individual risk factors. Multivariable logistic regression was then performed to adjust for confounding.
A total of 9,022 mid urethral sling surgeries were identified. The urinary tract infection incidence was 2.6%. Factors independently associated with an increased infection risk included age greater than 65 years (OR 1.54, 95% CI 1.07-2.22), body mass index greater than 40 kg/m (OR 1.89, 95% CI 1.23-2.92) and hospital admission (OR 2.06, 95% CI 1.37-3.11). Mid urethral sling surgery performed by urologists carried a reduced risk of infection compared to the surgery done by gynecologists (OR 0.52, 95% CI 0.40-0.69).
The urinary tract infection risk following mid urethral sling surgery in NSQIP associated hospitals is low. Novel patient and surgical factors for postoperative urinary tract infection have been identified and merit further study.
经尿道中段吊带手术较为常见。文献中术后尿路感染的发生率有所不同，尿路感染的独立危险因素也尚未明确。本研究旨在确定经尿道中段吊带手术后尿路感染的发生率和危险因素。
我们从 2006 年至 2014 年的 NSQIP（国家手术质量改进计划）数据库中获取了接受吊带手术的女性患者回顾性队列。排除标准包括男性、非择期手术、完全依赖功能状态、术前感染、30 天内再次手术、ASA（美国麻醉医师协会）身体状况分级 4 级或更高、伴随手术以及手术时间超过 60 分钟。主要结局是经尿道中段吊带手术后 30 天内尿路感染的发生率。通过检查患者的人口统计学、合并症和手术变量来评估尿路感染的危险因素。采用 logistic 回归分析估计各危险因素的 OR。然后进行多变量 logistic 回归以调整混杂因素。
共确定了 9022 例经尿道中段吊带手术。尿路感染的发生率为 2.6%。与感染风险增加相关的因素包括年龄大于 65 岁（OR 1.54，95%CI 1.07-2.22）、BMI 大于 40 kg/m²（OR 1.89，95%CI 1.23-2.92）和住院（OR 2.06，95%CI 1.37-3.11）。与妇科医生相比，泌尿科医生进行的经尿道中段吊带手术感染风险降低（OR 0.52，95%CI 0.40-0.69）。
在 NSQIP 相关医院，经尿道中段吊带手术后尿路感染的风险较低。已经确定了与术后尿路感染相关的新的患者和手术因素，值得进一步研究。
