Urinary Tract Infections in Large Bowel Surgery: Impact of Anatomic Location, Operative Approach, and Ostomy CreationKatherine Anderson, MDDaniel Jupiter, PhD Bonnie Hodges, RN Glenda Goolsby, RN Harry T. Papaconstantinou, MD

Katherine Aurelia AndersonNothing to Disclose

*

Urinary Tract Infections (UTI)Most common hospital acquired infectionHigher rates in Colorectal SurgeryProcedural risk factors not well defined$$$

Does anatomic location and approach of colon resection influence the likelihood of acquiring a UTI???

*

MethodsNSQIP 2005-2012CPT codes: LocationRightLeftLARAPROpen vs LapararoscopicOstomy vs. Primary Anastamosis*

MethodsOther variables including:GenderASA classBMISmoking historyStatistical analysis was performed using chi-squared test and t-test/anovaMultivariate logistic regression for occurrence of UTI was built

*

DEMOGRAPHICSTotal of 134,149 patients69,263 females (52%)4,776 with UTI (3.55%)

*

% UTI by Demographics

Chart1

0.0201

0.0262

0.046

0.0694

0.1268

0.0249

0.0455

% UTI

%UTI

Sheet1

Column1% UTI

ASA I2.01%

ASA II2.62%

ASA III4.60%

ASA IV6.94%

ASA V12.68%

Male2.49%

Female4.55%

To update the chart, enter data into this table. The data is automatically saved in the chart.

% UTI by Procedure

Chart1

0.029

0.032

0.0406

0.0677

0.029

0.055

*

Series 1

% UTI

% Incidence of UTI based on Procedure

Sheet1

Series 1

Right Colectomy2.90%

Left Colectomy3.20%

LAR4.06%

APR6.77%

Anastomosis2.90%

Ostomy5.50%

To update the chart, enter data into this table. The data is automatically saved in the chart.

Laparoscopic

Multivariate analysisIndependent significant risk factors for UTI in Colorectal Surgery:

% UTIOdds ratiop-valueRight Colectomy2.89%1Left Colectomy3.20%1.020.631LAR4.06%1.250.00001APR6.77%1.55

SummaryUTIs are more prevalent in colorectal surgeryAnatomic location and approach of colon resection influence the likelihood

CONCLUSIONSNeed to identify intraoperative and postoperative strategies to reduce UTI according to specific risk factorsReduce costImprove surgical outcome

Questions??

Thank you Dr. ______. Society members and guests, this afternoon, we will be discussing Urinary Tract Infections in Colorectal surgery and procedural risk factors for UTIs following colorectal operations. *Centers for Medicare and Medicaid Services no longer reimburse hospitals for costs associated with the development of HAI CAUTIs- thus it is imperitive to identify patients at high risk and implement prevention strategies aimed at reducing the health and financial burden to both the patient and hospitals. Hypothesis: Does anatomic location and approach of colon resection influence the likelihood of acquiring a catheter related UTI? Not much literature out there. SSI have been shown to be less in Right vs. Left. APR will likely be highest because of instrumentation and operating in the perineum.

*We included patients all patients undergoing Colorectal Surgery. Excluded trauma and age less than 18. We obtained the data files from the NSQIP for the calendar years 2005-2012 using the CPT codes we stratified colorectal procedures by anatomic location. We extracted NSQIP data for CPT codes for right sided colectomy, left-sided colectomy, low anterior resection, and abdominoperineal resection. Along with CPT codes, gender, BMI, ASA class, smoking history, and occurrence of UTI were analyzed. The association of anatomic region, ostomy, open vs lap and the demographic factors (gender, ASA, smoking history, and BMI) was assessed using chi-squared test or t-test/anova for discrete and continuous variables, respectively. The association of anatomic region, ostomy, open vs lap, demographic factors and occurrence of UTI was assessed in the same way. A multivariate logistic regression for occurrence of UTI including the surgical and demographic variables was built.

*The association of anatomic region, ostomy, open vs lap and the demographic factors (gender, ASA, smoking history, and BMI) was assessed using chi-squared test or t-test/anova for discrete and continuous variables, respectively. The association of anatomic region, ostomy, open vs lap, demographic factors and occurrence of UTI was assessed in the same way. A multivariate logistic regression for occurrence of UTI including the surgical and demographic variables was built.

*Results**Laparoscopic surgery- intraoperatively less tissue handling, postoperatively less pain, early ambulation, quicker removal of catheter, Urinary retention- the further distal, more likely to have urinary retention ( Kang et. Al)Limitations: Unknown length of catheter days.

*

Our data show that anatomic location, surgical approach, and ostomy creation are procedural specific risk factors that affect prevalence of UTI in colorectal surgery. These data indicate an opportunity to improve surgical outcomes for patients and reduce costs. The proper preventative measures are needed to identify intraoperative and postoperative strategies to reduce UTI according to specific risk factors in these patients*Id like to thank the Southwestern Surgical Congress for the opportunity to present our data, and the privilege of the podium.*