Impact of Perioperative Urinary Tract Infection on Surgical Site Infection in Patients Undergoing Primary Hip and Knee Arthroplasty |
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| Institution: | Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL;Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand;Department of Orthopaedics, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand;Otago Medical School, University of Otago, Dunedin, New Zealand;Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand;Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ;Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ;University Orthopaedic Associates, Somerset, NJ;Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany;OrthoCarolina Hip and Knee Center, Charlotte, NC;OrthoCarolina Research Institute, Charlotte, NC;OrthoCarolina Hip and Knee Center, Charlotte, NC;OrthoCarolina Research Institute, Charlotte, NC;OrthoCarolina Hip and Knee Center, Charlotte, NC;OrthoCarolina Hip and Knee Center, Charlotte, NC;Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India;Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY;Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY;Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY |
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| Abstract: | BackgroundThe literature lacks clear consensus regarding the association between postoperative urinary tract infection (UTI) and surgical site infection (SSI). Additionally, in contrast to preoperative asymptomatic bacteriuria, SSI risk in patients with preoperative UTI has been incompletely studied. Therefore, our goal was to determine the effect of perioperative UTI on SSI in patients undergoing primary hip and knee arthroplasty.MethodsUsing the National Surgical Quality Improvement Program database, all patients undergoing primary hip and knee arthroplasty were identified. Univariate and multivariate regressions, as well as propensity matching, were used to determine the independent risk of preoperative and postoperative UTI on SSI, reported as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsPostoperative UTI significantly increased the risk for superficial wound infection (OR 2.147, 95% CI 1.622-2.842), deep periprosthetic joint infection (PJI) (OR 2.288, 95% CI 1.579-3.316), and all SSIs (superficial and deep) (OR 2.193, 95% CI 1.741-2.763) (all P < .001). Preoperative UTI was not associated with a significantly increased risk of superficial infection (P = .636), PJI (P = .330), or all SSIs (P = .284). Further analysis of UTI present at the time of surgery using propensity matching showed no increased risk of superficial infection (P = 1.000), PJI (P = .624), or SSI (P = .546).ConclusionPostoperative UTI was associated with SSI, reinforcing the need to minimize factors which predispose patients to the risk of UTI after surgery. The lack of association between preoperative UTI and SSI suggests that hip and knee arthroplasty can proceed without delay, although initiating antibiotic treatment is prudent and future prospective investigations are warranted. |
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| Keywords: | urinary tract infection total hip arthroplasty total knee arthroplasty infection periprosthetic joint infection outcomes |
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