Retrospective review OBJECTIVE.: Compare post-operative infection rates and 30-day outcomes in spine surgery patients with and without a pre-operative urinary tract infection (UTI).
There is mixed evidence regarding safety and risks when operating on spine patients with a pre-operative UTI.
Using data from the American College of Surgeons National Surgical Quality Improvement Program, we identified all adult patients undergoing spine surgery between 2012-2017 with a pre-operative UTI. Patients with other pre-operative infections were excluded. Our primary outcome was any post-operative infection (pneumonia, sepsis, surgical site infection, and organ space infection). Our secondary outcomes included surgical site infections, non-infectious complications, return to operating room, and 30-day readmission and mortality. We used univariate, then multivariate Poisson regression models adjusted for demographics, comorbidities, laboratory values, and case details to investigate the association between pre-operative UTI status and post-operative outcomes.
270,371 patients who underwent spine surgery were analyzed. The most common procedure was laminectomy (41.9%), followed by spinal fusion (31.7%) and laminectomy/fusion (25.6%). 341 patients had a pre-operative UTI (0.14%). Patients with a pre-operative UTI were more likely to be older, female, inpatients, emergency cases, with a higher ASA score, and a longer operating time (for all, P < 0.001). Patients with a pre-operative UTI had higher rates of infectious and non-infectious complications, return to OR, and unplanned readmissions (for all, P < 0.001). However, there was no significant difference in mortality (0.6% vs. 0.2%, P = 0.108). Even after controlling for demographics, comorbidities, labs, and case details, pre-operative UTI status was significantly associated with more post-operative infectious complications (IRR: 2.88, 95% CI: 2.25-3.70, P < 0.001).
Pre-operative UTI status is significantly associated with post-operative infections and worse 30-day outcomes. Spine surgeons should consider delaying or cancelling surgery in patients with a UTI until the infection has cleared to reduce adverse outcomes.