Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMC Geriatr. 2022 Oct 28;22(1):828. doi: 10.1186/s12877-022-03461-1.
Among older adults, postoperative urinary tract infection is associated with significant harms including increased risk of hospital readmission and perioperative mortality. While risk of urinary tract infection is known to increase with age, the independent association between frailty and postoperative urinary tract infection is unknown. In this study we used 2014-2018 data from the U.S. National Surgical Quality Improvement Program (NSQIP) to investigate whether frailty is an independent risk factor for postoperative urinary tract infection, controlling for age and other relevant confounders.
Frailty was assessed using the modified Frailty Index. Postoperative urinary tract infection was defined as any symptomatic urinary tract infection (of the kidneys, ureters, bladder, or urethra) developing within 30 days of the operative procedure. To examine associations between frailty and other specific factors and postoperative urinary tract infection, chi squared tests, students t-tests, and logistic regression modelling were used.
Urinary tract infection was identified after 22,356 of 1,724,042 procedures (1.3%). In a multivariable model controlling for age and other patient and surgical characteristics, the relative odds for urinary tract infection increased significantly with increasing frailty score. For example, compared to a frailty score of 0, the relative odds for urinary tract infection for a frailty score of 3 was 1.50 (95% confidence interval 1.41, 1.60). The relative odds associated with the maximum frailty score (5) was 2.50 (95% confidence interval 1.73, 3.61).
Frailty is associated with postoperative urinary tract infection, independent of age. Further research should focus on the underlying mechanisms and strategies to mitigate this risk among frail adults.
在老年人中，术后尿路感染与严重危害相关，包括增加住院再入院风险和围手术期死亡率。虽然尿路感染风险随年龄增长而增加，但衰弱与术后尿路感染之间的独立相关性尚不清楚。在这项研究中，我们使用了 2014-2018 年美国国家手术质量改进计划（NSQIP）的数据，调查衰弱是否是术后尿路感染的独立危险因素，同时控制年龄和其他相关混杂因素。
使用改良衰弱指数评估衰弱。术后尿路感染定义为手术 30 天内发生的任何症状性尿路感染（肾脏、输尿管、膀胱或尿道）。为了研究衰弱与其他特定因素和术后尿路感染之间的关联，我们使用了卡方检验、学生 t 检验和逻辑回归模型。
在 1724042 例手术中的 22356 例（1.3%）中发现了尿路感染。在控制年龄和其他患者及手术特征的多变量模型中，尿路感染的相对比值随衰弱评分的增加而显著增加。例如，与衰弱评分为 0 相比，衰弱评分为 3 的尿路感染相对比值为 1.50（95%置信区间 1.41，1.60）。与最大衰弱评分（5）相关的相对比值为 2.50（95%置信区间 1.73，3.61）。
衰弱与术后尿路感染相关，与年龄无关。进一步的研究应集中在衰弱成年人的潜在机制和减轻这种风险的策略上。
