414 - Risk Factors for Urinary Tract Infection following Cervical Spine Surg...

#414 Risk Factors for Urinary Tract Infection following Cervical Spine Surgery

Cervical Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

S.V. Nandyala (1)
A.J. Marquez-Lara (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Urinary tract infections (UTIs) are a common post-operative complication. The purpose of this study is to determine the risk factors associated with UTIs in patients who underwent cervical spine surgery using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Methods: The ACS NSQIP database was queried to identify patients who underwent cervical spine surgery from 2006-2011. Procedures were identified by Current Procedural Terminology (CPT) codes for anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), or posterior cervical decompression (PCD) without fusion. Two study cohorts were developed: patients with and without documented postoperative UTIs within 30 days of the procedure. Preoperative patient characteristics, surgery and hospital outcomes (operative time, length of stay (LOS)), 30-day complication rates, and mortality) were compared between groups. Statistical analysis was performed with SPSS v.20 using one-way ANOVA and χ2-tests to determine significant differences for continuous and categorical variables, respectively. Statistical significance was determined by p-values ≤ 0.05. Multivariate regression was performed to identify independent risk factors for UTIs.

Results: 8648 patients were identified in the NSQIP database who underwent cervical spine surgery of which 78 (0.9%) developed a postoperative UTI. The UTI cohort was significantly older (61.9 ±12.8years; p< .0001) than the control group (54.0±12years). Significant preoperative risk factors for developing an UTI include African American ethnicity, diabetes mellitus, cardiomyopathy, hypertension, peripheral vascular disease, paralysis, history of TIA/CVA, metastatic cancer, open wound infection, bleeding disorder, and recent operation within thirty days (p< 0.05). PCF was performed in 17.9% of patients in the UTI cohort and was a significant surgical risk factor (p < 0.05). The UTI cohort experienced a greater mean operative time (155.4±86.1; p=.004) and LOS (9.2±11.1; p< .0001) than the control group ((132.9±67.9), (2.0±4.1) respectively). Thirty day outcomes demonstrated the UTI cohort had a significantly greater rate of readmissions and reoperations (p< 0.05). Significant associated thirty day complications reported in the UTI cohort include wound infections, pneumonia, unplanned intubation, pulmonary embolism, ventilator time >48 hours, peripheral nerve injury, cardiac event, and sepsis (p< 0.05). Mortality was greater in the UTI cohort (1.2%; p< 0.0.5) than in the control group (0.2%). Multivariate regression revealed independent predictors for UTI's to include age >65, female gender, African American ethnicity, recent operation within 30 days, operative time, and the PCF technique (p< 0.05).

Conclusion: Postoperative UTIs are associated with other complications that include wound infections, pneumonia, sepsis, and cardiopulmonary events. Patients suffering from a post-operative UTI experience a greater hospitalization and mortality rate. Identifiable risk factors for UTIs following cervical spine surgery include African American ethnicity, female gender, age >65 years, operative time, prior operation within 30 days, and the PCF technique.