title: Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures.
abstract: OBJECTIVE
  To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures.
  
  
  METHODS
  Review of literature, critical analysis of data and tentative model for reducing infectious complications.
  
  
  RESULTS
  Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical field is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient.
  
  
  CONCLUSIONS
  It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients' risk factors and classification of urological procedures.
authors.affiliation: Department of Urology, Skåne University Hospital, S-20502, Malmö, Sweden. magnus.grabe@skane.se
authors.forename: Magnus
authors.initials: M
authors.lastname: Grabe
authors.forename: Henry
authors.initials: H
authors.lastname: Botto
authors.forename: Mete
authors.initials: M
authors.lastname: Cek
authors.forename: Peter
authors.initials: P
authors.lastname: Tenke
authors.forename: Florian M E
authors.initials: FM
authors.lastname: Wagenlehner
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Naber
authors.forename: Truls E
authors.initials: TE
authors.lastname: Bjerklund Johansen
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000517:prevention & control*; D013520:Urologic Surgical Procedures / Q000379:methods*