Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy.

INTRODUCTION AND HYPOTHESIS: Urinary tract infections (UTIs) are the most common complication following hysterectomy and mid-urethral sling procedures (MUS). As a MUS is often placed at the time of hysterectomy, we sought to determine if the addition of an MUS procedure significantly increases the risk of UTI in the first 30 days following hysterectomy. METHODS: This retrospective cohort study utilizes the National Surgical Quality Improvement Program (NSQIP) data bank for the years 2006-2012. The database collects data on all enrolled patients preoperatively and in the first 30 days postoperatively. The database was searched using procedural codes for various types of hysterectomies and MUS procedures. We assessed the incidence of postoperative UTIs following hysterectomy (HYST) only, MUS only, and hysterectomy combined with MUS (HYST + MUS). Adjusted logistic regression analyses were performed to evaluate the effects of individual risk factors and models of interaction. RESULTS: The NSQIP cohort included 3,757 in the HYST + MUS group, 9,851 in the MUS-only group, and 57,398 in the HYST-only group. The rates of postoperative UTI, which was the most common postoperative morbidity, were 5.3, 3.4, and 2.5 % respectively. Multivariate logistic regression analysis showed a persistent significant increase in rates of UTI (p < 0.001) between the MUS + HYST group and the HYST-only group. This significance was not maintained between the MUS-only group and the MUS + HYST group. CONCLUSIONS: Data from the NSQIP databank indicate that performing an MUS in combination with hysterectomy nearly doubles the risk of postoperative UTI over a hysterectomy alone.

The incidence of early and recurrent urinary tract infections after midurethral sling operations.

OBJECTIVE: To define the incidence of early and recurrent urinary tract infections (RUTIs) in the 12-month postoperative period following midurethral sling (MUS) operations and evaluate for risk factors. METHODS: This retrospective chart review compiled all urine analyses and urine culture results within 12 months of MUS surgery on all patients in the years 2006-2012 for which data were available. All coincident risk factors were tabulated. Statistical analysis was performed using SAS v 9.2 (SAS Institute, Cary, North Carolina). RESULTS: 141 MUS procedures were performed in the 6-year time frame utilizing standard antibiotic prophylaxis regimens. 133 had adequate data for analysis. 10 patients (7.5% confidence intervals [CI] [3.7-12.4]) developed an acute UTI in the first 8 weeks postoperatively. 3 of 121 patients (2.3% CI [0.5-5.9]) developed RUTIs in the first year following surgery. Bivariate and multiple logistic regression analyses of the data did not reveal any risk factors for either isolated postoperative UTIs or RUTIs. CONCLUSIONS: This study documents a low incidence of both acute and RUTIs in the female population undergoing MUS operations. These results support the current recommendations for perioperative prophylactic antibiotics for anti-incontinence procedures.