Zachary M Helmen1, Melissa C Helm1, Joseph H Helm1, Alexander Nielsen1, Tammy Kindel1, Rana Higgins1, Jon C Gould2. 1. Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA. 2. Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA. jgould@mcw.edu.
Abstract
BACKGROUND: In bariatric surgery patients, urinary tract infections (UTIs) are one of the most common postoperative infections. In this study, we sought to determine if preoperative patient factors and perioperative processes contribute to an increased risk of UTI. METHODS: A retrospective analysis was performed of patients who underwent bariatric surgery at a single institution between March 2012 and May 2016. Standard protocol was antibiotic prophylaxis with cefazolin. Patients with a penicillin allergy received clindamycin. Urinary catheters were placed selectively. A univariate and multivariate analyses were performed to determine risk factors for patients who developed a UTI within 30 days postoperatively. RESULTS: Six hundred ninety-four patients (82.7% female) underwent bariatric surgery in the study interval. UTIs were more common in females (4.9 vs. 1.7%, p = 0.12). On univariate analysis age, operative time, length of stay, urinary catheter placement, clindamycin prophylaxis, and revisional surgery were significantly correlated with UTI. A multivariate logistic regression model revealed the risk of UTI increased 5.38-fold [95% confidence interval (CI) 2.41-12.05] with clindamycin use, 6.37-fold [95% CI 2.22-18.18] with revision surgery, and 1.25-fold [95% CI 1.05-1.49] for every 5 years gained in age. CONCLUSIONS: Older age, clindamycin prophylaxis, and revisional procedures are significantly associated with an increased rate of UTI following bariatric surgery. Several identified variables are modifiable risk factors and targets for a quality improvement initiative to decrease the rate of UTI in bariatric surgery patients.
BACKGROUND: In bariatric surgery patients, urinary tract infections (UTIs) are one of the most common postoperative infections. In this study, we sought to determine if preoperative patient factors and perioperative processes contribute to an increased risk of UTI. METHODS: A retrospective analysis was performed of patients who underwent bariatric surgery at a single institution between March 2012 and May 2016. Standard protocol was antibiotic prophylaxis with cefazolin. Patients with a penicillinallergy received clindamycin. Urinary catheters were placed selectively. A univariate and multivariate analyses were performed to determine risk factors for patients who developed a UTI within 30 days postoperatively. RESULTS: Six hundred ninety-four patients (82.7% female) underwent bariatric surgery in the study interval. UTIs were more common in females (4.9 vs. 1.7%, p = 0.12). On univariate analysis age, operative time, length of stay, urinary catheter placement, clindamycin prophylaxis, and revisional surgery were significantly correlated with UTI. A multivariate logistic regression model revealed the risk of UTI increased 5.38-fold [95% confidence interval (CI) 2.41-12.05] with clindamycin use, 6.37-fold [95% CI 2.22-18.18] with revision surgery, and 1.25-fold [95% CI 1.05-1.49] for every 5 years gained in age. CONCLUSIONS: Older age, clindamycin prophylaxis, and revisional procedures are significantly associated with an increased rate of UTI following bariatric surgery. Several identified variables are modifiable risk factors and targets for a quality improvement initiative to decrease the rate of UTI in bariatric surgery patients.
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