The Warren Alpert School of Medicine, Brown University, Providence, RI.
Department of Neurosurgery, Rhode Island Hospital, Providence, RI.
Spine (Phila Pa 1976). 2021 Mar 1;46(5):337-346. doi: 10.1097/BRS.0000000000003794.
Retrospective review of prospectively collected data.
The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether postoperative UTI timing affects short-term outcomes.
Urinary tract infection (UTI) is a common post-surgical complication; however, the predominant timing, location, and potential differential effects have not been carefully studied.
We analyzed elective spine surgery patients from 2012 to 2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We grouped patients with postoperative UTI by day of onset relative to discharge, to create cohorts of patients who developed inpatient UTI and post-discharge UTI. We compared both UTI cohorts with a control (no UTI) population and with each other to identify differences in baseline characteristics including demographic, comorbidity and operative factors. We performed multivariate logistic regression to identify predictors of UTI in each cohort and to assess adjusted risks of poor outcomes associated with UTI timing.
A total of 289,121 patients met inclusion criteria and 0.88% developed UTI (n = 2553). Only 31.6% of UTIs occurred before discharge (n = 806), with 68.4% occurring after discharge (n = 1747). The inpatient UTI cohort had significantly longer operative time, more fusion procedures, more posterior procedures, and more procedures involving the lumbar levels than the post-discharge cohort. Predictors of inpatient UTI included procedure type, spine region, and approach. Predictors of post-discharge UTI included length-of-stay and discharge destination. Both UTI cohorts were significantly associated with sepsis; however, post-discharge UTI carried a higher odds (adjusted odds ratio [aOR] = 24.90, 95% confidence interval [CI] = 21.05-29.45, P < 0.001 vs. aOR = 14.31, 95% CI = 11.09-18.45, P < 0.001). Inpatient UTI was not associated with 30-day readmission, although post-discharge UTI was (aOR = 8.23, 95% CI = 7.36-9.20, P < 0.001). Conversely, inpatient UTI was associated with increased odds of 30-day mortality (aOR = 3.23, 95% CI = 1.62-6.41, P = 0.001), but post-discharge UTI was not.
Predictive factors and outcomes differ based on timing of UTI after elective spine surgery. Before discharge, procedure -specific details predict UTI, but after discharge they do not. These findings suggest that traditional thinking about UTI prevention may need modification.Level of Evidence: 3.
前瞻性收集数据的回顾性研究。
本研究旨在探讨择期脊柱手术后尿路感染（UTI）发生时间的相关危险因素，并确定术后 UTI 发生时间是否会影响短期结局。
尿路感染（UTI）是一种常见的术后并发症；然而，其主要发生时间、部位以及潜在的差异影响尚未得到仔细研究。
我们分析了 2012 年至 2018 年 ACS 国家手术质量改进计划（NSQIP）中的择期脊柱手术患者。我们根据术后 UTI 发病日期与出院日期的关系，将患者分为住院 UTI 组和出院后 UTI 组。我们将这两个 UTI 组与无 UTI 对照组进行比较，并相互比较，以确定基线特征（包括人口统计学、合并症和手术因素）方面的差异。我们进行了多变量逻辑回归，以确定每个队列中 UTI 的预测因素，并评估与 UTI 发生时间相关的不良结局的调整风险。
共有 289121 名患者符合纳入标准，其中 0.88%（n=2553）发生 UTI。只有 31.6%（n=806）的 UTI 发生在出院前，68.4%（n=1747）发生在出院后。住院 UTI 组的手术时间明显较长，融合手术更多，后路手术更多，涉及腰椎的手术更多。住院 UTI 的预测因素包括手术类型、脊柱区域和手术入路。出院后 UTI 的预测因素包括住院时间和出院去向。两个 UTI 组均与脓毒症显著相关；然而，出院后 UTI 的可能性更高（调整后优势比[aOR]为 24.90，95%置信区间[CI]为 21.05-29.45，P<0.001 比 aOR 为 14.31，95% CI 为 11.09-18.45，P<0.001）。住院 UTI 与 30 天再入院无关，尽管出院后 UTI 与之相关（aOR 为 8.23，95% CI 为 7.36-9.20，P<0.001）。相反，住院 UTI 与 30 天死亡率增加相关（aOR 为 3.23，95% CI 为 1.62-6.41，P=0.001），但出院后 UTI 则不然。
择期脊柱手术后 UTI 发生时间的预测因素和结局不同。在出院前，特定于手术的细节可以预测 UTI，但出院后则不行。这些发现表明，传统的 UTI 预防观念可能需要改变。
3。
