Crouser Nisha, Malik Azeem Tariq, Phieffer Laura S, Ly Thuan V, Khan Safdar N, Quatman Carmen E
Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
J Clin Orthop Trauma. 2019 Jul-Aug;10(4):774-778. doi: 10.1016/j.jcot.2018.07.014. Epub 2018 Jul 19.
Pre-operative urinary tract infection (UTI) may be associated with a high rate of complications following surgeries. Few studies have investigated the clinical impact of a pre-operative UTI on post-operative outcomes following surgeries for hip-fracture in geriatric patients.
The 2015-2016 ACS-NSQIP database was queried for patients undergoing hip fracture surgery using CPT-Codes for Total Hip Arthroplasty (27130), Hemiarthroplasty (27125) and Open Reduction/Internal Fixation (ORIF) (27236, 27244, 27245). Only patients ≥65 years of age undergoing surgery due to a traumatic hip fracture were included in the study.
Out of 31,621 patients undergoing surgical treatment for a hip fracture, 410 (1.3%) had UTI at the time of the surgery. Following adjusted logistic regression analysis, UTI present at the time of surgery was associated with a longer length of stay>5 days (OR 5.46 [95% CI 2.27-13.1]; p = 0.008), any complication (OR 1.33 [95% CI 1.49-1.63]; p = 0.007), infectious complications (OR 1.71 [95% CI 1.19-2.47]; p = 0.004), non-infectious complications (OR 1.28 [95% CI 1.04-1.58]; p = 0.021), 30-day unplanned re-operations (OR 1.96 [95% CI 1.25-3.06]; p = 0.003) and 30-day readmissions (OR 2.04 [95% CI 1.57-2.66]; p < 0.001). With regards to infectious complications, presence of a UTI at time of surgery was a significant independent predictor of sepsis (OR 2.44 [95% CI 1.24-4.80]; p = 0.010) and septic shock (OR 4.05 [95% CI 2.03-8.08]; p < 0.001).
Patients undergoing hip-fracture surgery with a concurrent UTI at the time of surgery have more adverse 30-day outcomes as compared to hip fracture patients who do not present with a UTI. Despite adjustment for a delay in the time to surgery, the impact of UTI on post-operative outcomes remained significant. While it is difficult to eradicate a UTI in a non-elective population, the findings stress the need for clinical optimization and potential need for early recognition/management of UTI in patients who sustain a hip fracture to minimize the risk of adverse outcomes.
术前尿路感染（UTI）可能与术后高并发症发生率相关。很少有研究调查术前UTI对老年患者髋部骨折手术后的临床影响。
使用全髋关节置换术（27130）、半髋关节置换术（27125）和切开复位/内固定术（ORIF）（27236、27244、27245）的CPT编码，查询2015 - 2016年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库中接受髋部骨折手术的患者。本研究仅纳入因创伤性髋部骨折接受手术的65岁及以上患者。
在31621例接受髋部骨折手术治疗的患者中，410例（1.3%）在手术时患有UTI。经过调整的逻辑回归分析显示，手术时存在UTI与住院时间延长>5天相关（比值比[OR] 5.46 [95%置信区间（CI）2.27 - 13.1]；p = 0.008）、任何并发症（OR 1.33 [95% CI 1.49 - 1.63]；p = 0.007）、感染性并发症（OR 1.71 [95% CI 1.19 - 2.47]；p = 0.004）、非感染性并发症（OR 1.28 [95% CI 1.04 - 1.58]；p = 0.021）、30天内非计划再次手术（OR 1.96 [95% CI 1.25 - 3.06]；p = 0.003）以及30天内再入院（OR 2.04 [95% CI 1.57 - 2.66]；p < 0.001）。关于感染性并发症，手术时存在UTI是脓毒症（OR 2.44 [95% CI 1.24 - 4.80]；p = 0.010）和感染性休克（OR 4.05 [95% CI 2.03 - 8.08]；p < 0.001）的显著独立预测因素。
与手术时无UTI的髋部骨折患者相比，手术时并发UTI的髋部骨折患者30天不良结局更多。尽管对手术时间延迟进行了调整，但UTI对术后结局的影响仍然显著。虽然在非择期人群中难以根除UTI，但研究结果强调了临床优化的必要性以及对髋部骨折患者早期识别/管理UTI以尽量降低不良结局风险的潜在需求。
