title: Impact of urinary tract infection definitions on colorectal outcomes.
abstract: BACKGROUND
  Hospital-acquired urinary tract infections (UTIs) significantly impact hospital outcomes. Colorectal surgery is inherently high risk for postoperative infections including UTI, and these patients may have unique outcomes as compared to other medical and surgical hospitalizations. We aim to assess the impact of the differing definitions of UTI captured by our hospital quality measures on hospital charges, length of stay (LOS), and mortality after colorectal resections at our institution.
  
  
  METHODS
  Existing hospital quality surveillance was used to retrospectively identify postcolorectal resection UTI, as defined by the National Surgical Quality Improvement Program (NSQIP), and the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN)-defined catheter-associated UTIs (CAUTI), from 2006-2012. Both groups were compared to colorectal resections performed during the same period that did not develop a UTI. Groups were compared for differences in 30-d surgical outcomes with multivariate analysis of total hospital charges and LOS.
  
  
  RESULTS
  During our study period, we identified 18 CAUTIs and 42 NSQIP-UTI, and 1064 other colorectal resections (UTI rate, 5.3%). Our overall mortality rate was 4.4% and was not associated with CAUTI or NSQIP-UTI on univariate analysis. CAUTI, but not NSQIP-UTI, was associated with a 73% increase in LOS and 70% increase in total hospital charges on multivariate analysis.
  
  
  CONCLUSIONS
  By reviewing quality outcomes surveillance modalities at our hospital, we identified postcolorectal resection CAUTI, but not NSQIP-UTI, to be associated with increased total hospital charges and LOS. Neither was associated with mortality.
authors.affiliation: Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: john-byrn@uiowa.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Byrn
authors.affiliation: Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Brooks
authors.affiliation: Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Mary
authors.initials: M
authors.lastname: Belding-Schmitt
authors.affiliation: Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Jill C
authors.initials: JC
authors.lastname: Furgason
authors.affiliation: Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology / Q000401:mortality; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D009626:Terminology as Topic; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000191:economics* / Q000209:etiology / Q000401:mortality