Pd62-06 Does Urine Culture Before Endoscopic Prostate Surgery Decrease Postoperative Urinary Tract Infection? An Analysis of the Veterans Affairs National Surgical Database

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety III (PD62)1 May 2024PD62-06 DOES URINE CULTURE BEFORE ENDOSCOPIC PROSTATE SURGERY DECREASE POSTOPERATIVE URINARY TRACT INFECTION? AN ANALYSIS OF THE VETERANS AFFAIRS NATIONAL SURGICAL DATABASE Muhieddine Labban, William J. O'Brien, Kalpana Gupta, and Lori Lerner Muhieddine LabbanMuhieddine Labban , William J. O'BrienWilliam J. O'Brien , Kalpana GuptaKalpana Gupta , and Lori LernerLori Lerner View All Author Informationhttps://doi.org/10.1097/01.JU.0001008656.89655.67.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic prostate surgery is well known to increase the risk of bacteremia and is classified as a high risk for surgical site infection. For many surgeons, preoperative urine culture (UCX) results are used as an indicator of patient safety. Despite this, many urologists do not check UCX; and postoperative urinary tract infection (UTI) can occur irrespective of UCX-directed perioperative antibiotics. We evaluated whether preoperative UCX impacted the incidence of postoperative UTI in a large cohort of at-risk patients undergoing endoscopic prostate surgery. METHODS: We queried the Veterans Affairs National Surgical Database (2015-2022) for transurethral resection of the prostate (TURP), laser enucleation, laser vaporization, and Redo-TURP. We defined preoperative UCX as obtained within 30 days of surgery. The primary endpoint was postoperative UTI within 30 days. We included demographics and comorbidities, including if veterans had a historically positive UCX within a year before surgery. We compared baseline covariates between uninfected and those with postoperative UTI. Then, we fitted a multivariable logistic regression to examine the effect of preoperative UCX on the odds of postoperative UTI adjusting for veteran covariates and type of procedure. RESULTS: Of 22,825 veterans, 19,056 (83.5%) had a preoperative UCX. Veterans with a history of positive UCX were more likely to have a postoperative UTI (33.3% vs. 27.1%; p<0.001). After adjusting for covariates, preoperative UCX did not decrease the risk of postoperative UTI (aOR 0.89; 95%CI [0.72-1.10]; p=0.29) (Table 1). Additionally, men with historically positive UCX had increased odds (aOR 1.33; 95%CI 1.13-1.57]; p<0.01) of postoperative UTI. CONCLUSIONS: We found that preoperative UCX did not reduce the risk of postoperative UTI among men who had endoscopic prostate surgery. However, veterans with a historically positive UCX were more likely to have postoperative UTI. This suggests that routine preoperative UCX does not necessarily make surgery safer and can be guided by the patient's risk profile. It is possible that at-risk patients may be better served by broader spectrum perioperative antibiotics in lieu of UCX testing and/or UCX-guided antibiotics. Source of Funding: This work is funded by the Veteran Affairs Health Services Research and Development Merit Award © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1287 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Muhieddine Labban More articles by this author William J. O'Brien More articles by this author Kalpana Gupta More articles by this author Lori Lerner More articles by this author Expand All Advertisement PDF downloadLoading ...