Urinary tract infection (UTI) at time of geriatric hip fracture surgery increases the risk of experiencing adverse 30-day outcomes

Abstract

IntroductionPre-operative urinary tract infection (UTI) may be associated with a high rate of complications following surgeries. Few studies have investigated the clinical impact of a pre-operative UTI on post-operative outcomes following surgeries for hip-fracture in geriatric patients. MethodsThe 2015–2016 ACS-NSQIP database was queried for patients undergoing hip fracture surgery using CPT-Codes for Total Hip Arthroplasty (27130), Hemiarthroplasty (27125) and Open Reduction/Internal Fixation (ORIF) (27236, 27244, 27245). Only patients ≥65 years of age undergoing surgery due to a traumatic hip fracture were included in the study. ResultsOut of 31,621 patients undergoing surgical treatment for a hip fracture, 410 (1.3%) had UTI at the time of the surgery. Following adjusted logistic regression analysis, UTI present at the time of surgery was associated with a longer length of stay>5 days (OR 5.46 [95% CI 2.27–13.1]; p = 0.008), any complication (OR 1.33 [95% CI 1.49–1.63]; p = 0.007), infectious complications (OR 1.71 [95% CI 1.19–2.47]; p = 0.004), non-infectious complications (OR 1.28 [95% CI 1.04–1.58]; p = 0.021), 30-day unplanned re-operations (OR 1.96 [95% CI 1.25–3.06]; p = 0.003) and 30-day readmissions (OR 2.04 [95% CI 1.57–2.66]; p < 0.001). With regards to infectious complications, presence of a UTI at time of surgery was a significant independent predictor of sepsis (OR 2.44 [95% CI 1.24–4.80]; p = 0.010) and septic shock (OR 4.05 [95% CI 2.03–8.08]; p < 0.001). ConclusionsPatients undergoing hip-fracture surgery with a concurrent UTI at the time of surgery have more adverse 30-day outcomes as compared to hip fracture patients who do not present with a UTI. Despite adjustment for a delay in the time to surgery, the impact of UTI on post-operative outcomes remained significant. While it is difficult to eradicate a UTI in a non-elective population, the findings stress the need for clinical optimization and potential need for early recognition/management of UTI in patients who sustain a hip fracture to minimize the risk of adverse outcomes.