Incidence of and risk factors for postoperative urinary tract infection in women undergoing colpopexy

Sheyn D1, Soriano A2, Mahajan S3

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 15
Urogynaecology 1 - Pelvic Organ Prolapse
Scientific Podium Short Oral Session 2
Wednesday 4th September 2019
10:00 - 10:07
Hall H2
Pelvic Organ Prolapse Surgery Infection, Urinary Tract
1.University Hopitals and Case Western Reserve University School of Medicine, 2.Hospital of the University of Pennsylvania, 3.University Hospitals and Case Western Reserve University School of Medicine
Presenter
S

Sangeeta Mahajan

Links

Abstract

Hypothesis / aims of study
Postoperative urinary tract infection (UTI) is a quality indicator for pelvic surgery and poses substantial health care costs. However, prior studies report significant variability in the rate of postoperative urinary tract infection (UTI) after colpopexy ranging from 10-25%. Our aim was to utilize a large database to determine the rate of UTI in women undergoing colpopexy. A secondary aim was to identify risk factors and timing for UTIs in women undergoing colpopexy.
Study design, materials and methods
Using the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified a cohort of 23,097 women who underwent colpopexy between 2010 to 2017. Patients were separated into 2 groups: those with and without postoperative UTI. Postoperative UTI was defined as a positive culture and symptoms within 30 days of surgery. Data were analyzed using univariate and multivariable logistic regression. A univariate analysis screen followed by multivariable logistic regression compared specific patient demographics, comorbidities, operative characteristics and intraoperative and postoperative complications between the two groups. Additional analyses were performed to determine timing of UTI in the first 30 days after surgery.
Results
Overall 1,079 (4.7%) women who underwent colpopexy experienced a postoperative UTI. Women undergoing a vaginal colpopexy (intra- or extraperitoneal) were more likely to develop a postoperative UTI compared to abdominal colpopexy (open or laparoscopic) (5.6% versus 3.6%, p<0.001). UTI was most frequently diagnosed in the 2nd week after surgery, 38.2%; compared to weeks 1, 3 and 4: 19.9%, 22.8%, and 19.1%, respectively.Additionally UTIs were more common in women undergoing anterior colporrhaphy (34.5% vs 25.9%, p<0.001), posterior colporrhaphy (42.3% vs 33.7%, p<0.001), and sling procedures (44.7% vs 33.7%, p<0.001). Intraoperative cystotomy was identified as the most predictive variable for a postoperative UTI (aOR=2.93; 95% CI, 1.54-5.59). On multivariate analysis, the following characteristics remained independently associated with increased risk of UTI: intraperitoneal vaginal colpopexy (aOR=1.72, 95%CI: 1.47-2.01), extraperitoneal vaginal colpopexy (aOR=1.65, 95%CI: 1.39-1.96), insulin dependent diabetes mellitus (aOR=1.65, 95% CI:1.13-2.41), chronic steroid use (aOR=1.55, 95%CI: 1.05-2.27), mid-urethral sling procedure (aOR=1.47, 95%CI: 1.29-1.67) , length of hospitalization (aOR=1.24, 95%CI: 1.15-1.29), anterior colporrhaphy (aOR=1.17, 95%CI: 1.06-1.36), posterior colporrhaphy (aOR=1.15, 95%CI: 1.03-1.33) and operation time (aOR=1.02, 95%CI: 1.01-1.03).
Interpretation of results
The incidence of postoperative UTI in women undergoing colpopexy was relatively lower than previously published rates. Women undergoing a vaginal approach were at higher risk for postoperative UTI which is consistent with prior studies that demonstrate vaginal surgery as a risk factor for postoperative UTI. However, given the relatively low rates of UTI after both routes of colpopexy, this dataset is reassuring that both routes of colpopexy pose a smaller risk of postoperative UTI than previously reported. Interestingly, UTI rates peaked during the second week after surgery and rates of postoperative UTI were similar in the first and fourth week. Thus, patients remain at risk for a UTI throughout the first month after surgery and providers should have a low threshold to rule out a UTI within the first 30 days of surgery. Clinical variables such as insulin-dependent diabetes mellitus, chronic steroid use and longer hospitalizations were confirmed as risk factors for postoperative urinary infections. Conconminant vaginal procedures, either anterior or posterior colporrhaphy, increased the risk of postoperative UTI for women undergoing vaginal colpopexy but not for abdominal colpopexy. The rates of UTI were even higher for those patients with both an anterior and posterior colporrhaphy. This indicates that the length of vaginal surgery may be an important factor in postoperative UTI. However, this database study did not account for length of postoperative transurethral catheter which was likely longer in patients undergoing anterior and posterior colporrhaphy. This important confounder is a limitation of the study.
Concluding message
This large database study demonstrated postoperative UTIs after colpopexy was lower than previously reported. Vaginal colpopexy is associated with a higher risk of UTI than abdominal or laparoscopic colpopexy.
Disclosures
<span class="text-strong">Funding</span> None <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> None