Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint ArthroplastyReport as inadecuate




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Advances in Orthopedics - Volume 2016 2016, Article ID 7268985, 5 pages -

Research ArticleFeinberg School of Medicine, Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair Street, Suite 1350, Chicago, IL 60611, USA

Received 17 July 2016; Accepted 15 November 2016

Academic Editor: Allen L. Carl

Copyright © 2016 Andrew P. Alvarez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Urinary tract infections UTIs are the most common minor complication following total joint arthroplasty TJA with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services CMS has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon’s National Surgical Improvement Program Database ACS-NSQIP. A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI. Results. 1,239 1.1% of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex OR 2.1, 95% CI 1.6–2.7, chronic steroid use OR 2.0, 95% CI 1.2–3.2, ages 60–69 OR 1.5, 95% CI 1.0–2.1, 70–79 OR 2.0, 95% CI 1.4–2.9, and ≥80 OR 2.3, 95% CI 1.5–3.6, ASA Classes 3–5 OR 1.5, 95% CI 1.2–1.9, preoperative creatinine >1.35 OR 1.8, 95% CI 1.3–2.6, and operation time greater than 130 minutes OR 1.8, 95% CI 1.3–2.4. Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement.





Author: Andrew P. Alvarez, Alysen L. Demzik, Hasham M. Alvi, Kevin D. Hardt, and David W. Manning

Source: https://www.hindawi.com/



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