1455 GFSD

Abstract

Study Objective To report rates and identify risk factors for urinary tract infection (UTI) following hysterectomy for benign conditions Design Retrospective cohort study (Canadian Task Force classification II-2) Setting American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database Patients or Participants Women undergoing benign hysterectomy by any modality between 2010 and 2017. Interventions Abdominal hysterectomy (AH), total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy (LAVH), vaginal hysterectomy (TVH) Measurements and Main Results 67,243 women included in the analysis with 1,310 postoperative UTIs identified, at a rate of 19.5 per 1000 hysterectomies. Women who developed UTIs were more likely to smoke (19.6% vs 15.7%, p=<0.001), have insulin dependent diabetes mellitus (IDDM) (3.7% vs 2.0%, p=<0.001), chronic obstructive pulmonary disease (1.5% vs 0.8%, p=0.007), use systemic steroids (2.2% vs 1.4%, p=0.01), had previous abdominal-pelvic surgery (71.1% vs 63.5%, p= <0.001), and be American Society of Anesthesiology (ASA) class ≥3 (26.1% vs 21.2%, p=<0.001). Procedures complicated by UTI were longer (148.1min +/-79.4 vs 135.5min +/-65.6, p=<0.001). Patients with a postoperative UTI were more likely to undergo TVH (12.9% vs 9.2%, p=<0.001), LAVH (13.5% vs 11.5%, p=0.02) and TLH (43.7% vs 40.4%, p=0.02); and less likely to undergo AH (25.5% vs 21.7%, p=0.004). Patients with UTIs were more likely to have surgeries complicated by cystotomy (1.5% vs 0.3%, p=<0.001), have endometriosis identified (15.7% vs 13.5%, p=0.02) and undergo adnexectomy (80.5% vs 77.9%, p=0.02). Perioperative transfusions were more common in women with postoperative UTI (5.8% vs 3.7%, p=<0.001). Following regression analysis, cystotomy (aOR=4.16, 95%CI=2.57-6.73) and TVH (aOR=2.45, 95%CI=1.99-2.99) were most strongly associated with increased odds of post-hysterectomy UTI. Additional independent predictors are listed in. Conclusion The risk of UTI after hysterectomy is low. Intraoperative cystotomy and vaginal hysterectomy are the most significant predictors of subsequent urinary tract infection. To report rates and identify risk factors for urinary tract infection (UTI) following hysterectomy for benign conditions Retrospective cohort study (Canadian Task Force classification II-2) American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database Women undergoing benign hysterectomy by any modality between 2010 and 2017. Abdominal hysterectomy (AH), total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy (LAVH), vaginal hysterectomy (TVH) 67,243 women included in the analysis with 1,310 postoperative UTIs identified, at a rate of 19.5 per 1000 hysterectomies. Women who developed UTIs were more likely to smoke (19.6% vs 15.7%, p=<0.001), have insulin dependent diabetes mellitus (IDDM) (3.7% vs 2.0%, p=<0.001), chronic obstructive pulmonary disease (1.5% vs 0.8%, p=0.007), use systemic steroids (2.2% vs 1.4%, p=0.01), had previous abdominal-pelvic surgery (71.1% vs 63.5%, p= <0.001), and be American Society of Anesthesiology (ASA) class ≥3 (26.1% vs 21.2%, p=<0.001). Procedures complicated by UTI were longer (148.1min +/-79.4 vs 135.5min +/-65.6, p=<0.001). Patients with a postoperative UTI were more likely to undergo TVH (12.9% vs 9.2%, p=<0.001), LAVH (13.5% vs 11.5%, p=0.02) and TLH (43.7% vs 40.4%, p=0.02); and less likely to undergo AH (25.5% vs 21.7%, p=0.004). Patients with UTIs were more likely to have surgeries complicated by cystotomy (1.5% vs 0.3%, p=<0.001), have endometriosis identified (15.7% vs 13.5%, p=0.02) and undergo adnexectomy (80.5% vs 77.9%, p=0.02). Perioperative transfusions were more common in women with postoperative UTI (5.8% vs 3.7%, p=<0.001). Following regression analysis, cystotomy (aOR=4.16, 95%CI=2.57-6.73) and TVH (aOR=2.45, 95%CI=1.99-2.99) were most strongly associated with increased odds of post-hysterectomy UTI. Additional independent predictors are listed in. The risk of UTI after hysterectomy is low. Intraoperative cystotomy and vaginal hysterectomy are the most significant predictors of subsequent urinary tract infection.