Preoperative Urinary Tract Infection and Outcomes After Prolapse Surgery

Importance Preoperative urinary tract infection (UTI) has been associated with worse 30-day perioperative outcomes in certain surgical specialties. Literature is limited regarding patients undergoing reconstructive pelvic surgery. Objective The objective of this study was to evaluate the effect of preoperative UTI on 30-day postoperative outcomes of patients undergoing prolapse surgery. Study Design This was a retrospective cohort study using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients undergoing prolapse surgery with and without preoperative UTI were compared with standard bivariate and multivariate logistic regression analysis as appropriate. Results In total, 86,619 patients underwent prolapse surgery: 273 (0.3%) patients had preoperative UTI. These patients were more likely to be older ( P <0.001), have a higher body mass index (BMI) ( P =0.009), have a higher American Society of Anesthesiologists (ASA) class ( P <0.001), undergo reoperation ( P =0.004) and readmission ( P <0.001). While the overall 30-day postoperative complication rate was similar between cohorts (7.0% vs. 6.1%, P =0.66), preoperative UTI was associated with a higher likelihood of deep/organ space surgical site infection ( P <0.001), perioperative transfusion ( P =0.01), and sepsis ( P <0.001). On multivariable logistic regression, preoperative UTI remained associated with increased odds of both readmission (adjusted odds ratio aOR: 4.8) and reoperation (aOR: 2.9). Conclusions Preoperative UTI was associated with an increased risk of deep/organ space surgical site infection, perioperative transfusion, sepsis, readmission, and reoperation in the 30 days after surgery. However, overall 30-day complication rates were similar between groups. Postponing elective prolapse surgery for patients with a UTI may improve perioperative outcomes.