Department of Neurosurgery, Yale University School of Medicine, New Haven, CT.
Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2020 Jun 1;45(11):747-754. doi: 10.1097/BRS.0000000000003382.
Retrospective review.
Compare postoperative infection rates and 30-day outcomes in spine surgery patients with and without a preoperative urinary tract infection (UTI).
There is mixed evidence regarding safety and risks when operating on spine patients with a preoperative UTI.
Using data from the American College of Surgeons National Surgical Quality Improvement Program, we identified all adult patients undergoing spine surgery between 2012 and 2017 with a preoperative UTI. Patients with other preoperative infections were excluded. Our primary outcome was any postoperative infection (pneumonia, sepsis, surgical site infection, and organ space infection). Our secondary outcomes included surgical site infections, non-infectious complications, return to operating room, and 30-day readmission and mortality. We used univariate, then multivariate Poisson regression models adjusted for demographics, comorbidities, laboratory values, and case details to investigate the association between preoperative UTI status and postoperative outcomes.
A total of 270,371 patients who underwent spine surgery were analyzed. The most common procedure was laminectomy (41.9%), followed by spinal fusion (31.7%) and laminectomy/fusion (25.6%). Three hundred fourty one patients had a preoperative UTI (0.14%). Patients with a preoperative UTI were more likely to be older, female, inpatients, emergency cases, with a higher American Society of Anesthesiologists score, and a longer operating time (for all, P < 0.001). Patients with a preoperative UTI had higher rates of infectious and non-infectious complications, return to operating room, and unplanned readmissions (for all, P < 0.001). However, there was no significant difference in mortality (0.6% vs. 0.2%, P = 0.108). Even after controlling for demographics, comorbidities, labs, and case details, preoperative UTI status was significantly associated with more postoperative infectious complications (incidence rate ratio [IRR]: 2.88, 95% confidence interval [CI]: 2.25-3.70, P < 0.001).
Preoperative UTI status is significantly associated with postoperative infections and worse 30-day outcomes. Spine surgeons should consider delaying or cancelling surgery in patients with a UTI until the infection has cleared to reduce adverse outcomes.
回顾性研究。
比较术前尿路感染（UTI）和无术前尿路感染的脊柱手术患者的术后感染率和 30 天结局。
对于患有术前 UTI 的脊柱患者进行手术的安全性和风险存在混合证据。
我们使用美国外科医师学会国家手术质量改进计划的数据，确定了 2012 年至 2017 年间所有接受脊柱手术且术前存在 UTI 的成年患者。排除了其他术前感染的患者。我们的主要结局是任何术后感染（肺炎、败血症、手术部位感染和器官间隙感染）。我们的次要结局包括手术部位感染、非感染性并发症、重返手术室以及 30 天再入院和死亡率。我们使用单变量和多变量泊松回归模型，根据人口统计学、合并症、实验室值和病例细节，调查术前 UTI 状态与术后结局之间的关联。
共分析了 270371 例接受脊柱手术的患者。最常见的手术是椎板切除术（41.9%），其次是脊柱融合术（31.7%）和椎板切除术/融合术（25.6%）。341 例患者术前存在 UTI（0.14%）。术前 UTI 的患者更可能年龄较大、女性、住院患者、急诊患者、美国麻醉医师协会评分较高、手术时间较长（所有患者，P<0.001）。术前 UTI 的患者发生感染和非感染性并发症、重返手术室和计划外再入院的比率较高（所有患者，P<0.001）。然而，死亡率没有显著差异（0.6%对 0.2%，P=0.108）。即使在控制了人口统计学、合并症、实验室和病例细节后，术前 UTI 状态与术后感染性并发症显著相关（发病率比 [IRR]：2.88，95%置信区间 [CI]：2.25-3.70，P<0.001）。
术前 UTI 状态与术后感染和 30 天不良结局显著相关。脊柱外科医生应考虑在感染清除后再延迟或取消患有 UTI 的患者的手术，以降低不良结局的风险。
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