STUDY DESIGN: Retrospective review of prospectively collected data.
OBJECTIVE: To determine the incidence and risk factors for development of a urinary tract infection (UTI) following a posterior lumbar fusion procedure.
SUMMARY OF BACKGROUND DATA: UTI following surgery is common and has important clinical consequences for both patients and the healthcare system. Few studies have examined UTI following spinal fusion procedures.
METHODS: Patients undergoing posterior lumbar fusion procedures during 2011-2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Statistical comparisons were made using multivariate regression with adjustment for demographic, comorbidity, and operative characteristics.
RESULTS: 10,825 patients met inclusion criteria. The incidence of a UTI was 1.77% (95% confidence interval [CI] = 1.52-2.02%). Independent risk factors for a UTI were greater age (for 50-59 years, RR = 1.0; 60-69 years, RR = 2.1; ≥70 years, RR = 3.5; p< 0.001), female sex (RR = 2.2, p< 0.001), dependent functional status (RR = 2.1, p = 0.010), malnutrition (RR = 2.3, p = 0.004), diabetic status (for non-insulin-dependent diabetes, RR = 1.5; for insulin-dependent diabetes, RR = 1.9; p = 0.011), and increased operative duration (for 120-179 minutes, RR = 1.4; 180-239 minutes, RR = 2.3; ≥240 minutes, RR = 2.7; p< 0.001).Patients who developed a UTI had a greater risk for systemic sepsis than other patients (11.5% versus 0.63%; adjusted RR = 14.4, p< 0.001). Patients who developed a UTI had a greater risk for readmission than other patients (36.7% versus 5.0%; adjusted RR = 6.1, p< 0.001).
CONCLUSIONS: UTIs occur in nearly 1 in 50 patients undergoing posterior lumbar fusion procedures. Patients who are older, female, dependent, malnourished, or diabetic are at greater risk and should be counseled and monitored accordingly. In addition, morbidity associated with a UTI in this population is substantial, as demonstrated by a 14-fold increase in the risk for systemic sepsis and a 6-fold increase in the risk for readmission. As such, increased preventative measures should be targeted to the patients identified here to be at greatest risk.
Bohl DD, Ahn J, Tabaraee E, Ahn J, Jain A, Grauer JN, Singh K. Are you the author?
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, New Haven, CT 06510; Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612; National Institute on Aging/National Institutes of Health, Biomedical Research Center, 251 Bayview Boulevard, Baltimore, MD 21224.
Reference: Spine (Phila Pa 1976). 2015 May 27. Epub ahead of print.