Urinary Tract Infections after Head and Neck Cancer Surgery

Abstract

Objective: Catheter-associated urinary tract infections (UTI) have been identified as a preventable “never event” by the Centers for Medicare and Medicaid Services (CMS). We sought to determine the relationship between UTI and in- hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery. Method: Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal or oropharyngeal neoplasm in 2003 through 2008 were analyzed using cross-tabulations and multivariate regression modeling. Results: UTI was diagnosed in 2% of patients. Patients with UTI were more likely to be over 80 years of age (OR = 3.3, P = .008), female (OR = 1.9, P < .001), have advanced comorbidity (OR = 1.8, P < .012), undergo major surgical procedures (OR = 1.7, P = .001), have predisposing bladder and prostate conditions (OR = 3.8, P < .001), experience surgical complications (OR = 2.3, P < .001), and have acute medical complications (OR = 3.1, P < .001). UTI was associated with significantly increased length of hospitalization and hospital-related costs, after controlling for all other variables. Conclusion: UTI is unusual in HNCA surgical patients but is more common with extent of surgery and age and is significantly associated with postoperative complications, length of hospitalization, and hospital-related costs. HNCA patients are a high-risk group for this “never event,” particularly as the population ages.