Postoperative urinary tract infection and short-term outcomes and costs in head and neck cancer surgery.
OBJECTIVE
Catheter-associated urinary tract infections (UTIs) have been identified as a preventable "never event" by the Centers for Medicare & Medicaid Services. We sought to determine the relationship between UTI and in-hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery.


METHODS
Cross-sectional analysis using cross-tabulations and multivariate regression modeling.


METHODS
The Nationwide Inpatient Sample database.


METHODS
Discharge data for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003-2008 were analyzed.


RESULTS
Urinary tract infection was diagnosed in 2% of patients, with catheter-associated UTI coded in only 20 patients. Patients with UTI were more likely to be older than 80 years (odds ratio [OR], 3.3; P = .008), be female (OR, 1.9; P < .001), have advanced comorbidity (OR, 1.8; P < .012), undergo major surgical procedures (OR, 1.7; P = .001), and have predisposing bladder and prostate conditions (OR, 3.8; P < .001), surgical complications (OR, 2.3; P < .001), and acute medical complications (OR, 3.1; P < .001). Urinary tract infection was associated with significantly increased length of hospitalization and hospital-related costs, after controlling for all other variables.


CONCLUSIONS
Urinary tract infection is unusual in HNCA surgical patients but is more common with extent of surgery and age and is significantly associated with postoperative complications, length of hospitalization, and hospital-related costs. Catheter-associated UTI is likely underestimated because of difficulty in distinguishing between a catheter-associated UTI and postoperative UTI in patients undergoing major surgical procedures, who routinely undergo perioperative urinary catheterization. Patients with HNCA are a high-risk group for this "never event," particularly as the population ages.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Jason Y K
JY
Chan
Yevgeniy R
YR
Semenov
Christine G
CG
Gourin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000191:economics*; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000191:economics* / Q000209:etiology