title: Urinary Tract Infection Following Posterior Lumbar Fusion Procedures: An American College of Surgeons National Surgical Quality Improvement Program Study.
abstract: METHODS
  Retrospective review of prospectively collected data.
  
  
  OBJECTIVE
  To determine the incidence and risk factors for the development of a urinary tract infection (UTI) after a posterior lumbar fusion procedure.
  
  
  BACKGROUND
  UTI after surgery is common and has important clinical consequences for both patients and the health care system. Few studies have examined UTI after spinal fusion procedures.
  
  
  METHODS
  Patients undergoing posterior lumbar fusion procedures during 2011 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Statistical comparisons were made using multivariate regression with adjustment for demographic, comorbidity, and operative characteristics.
  
  
  RESULTS
  A total of 10,825 patients met inclusion criteria. The incidence of a UTI was 1.77% (95% confidence interval = 1.52%-2.02%). Independent risk factors for a UTI were greater age (for 50-59 yr, relative risk [RR] = 1.0; 60-69 yr, RR = 2.1; ≥70 yr, RR = 3.5; P < 0.001), female sex (RR = 2.2, P < 0.001), dependent functional status (RR = 2.1, P = 0.010), malnutrition (RR = 2.3, P = 0.004), diabetic status (for non-insulin-dependent diabetes, RR = 1.5; for insulin-dependent diabetes, RR = 1.9; P = 0.011), and increased operative duration (for 120-179  min, RR = 1.4; 180-239  min, RR = 2.3; and for ≥240  min, RR = 2.7; P < 0.001).Patients who developed a UTI had a greater risk for systemic sepsis than other patients (11.5% vs. 0.63%; adjusted RR = 14.4, P < 0.001). Patients who developed a UTI had a greater risk for readmission than other patients (36.7% vs. 5.0%; adjusted RR = 6.1, P < 0.001).
  
  
  CONCLUSIONS
  UTIs occur in nearly 1 in 50 patients undergoing posterior lumbar fusion procedures. Patients who are older, female, dependent, malnourished, or diabetic are at greater risk and should be counseled and monitored accordingly. In addition, morbidity associated with a UTI in this population is substantial, as demonstrated by a 14-fold increase in the risk for systemic sepsis and a 6-fold increase in the risk for readmission. As such, increased preventative measures should be targeted to the patients identified here to be at greatest risk.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT†Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL‡National Institute on Aging/National Institutes of Health, Biomedical Research Center, Baltimore, MD.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.forename: Ehsan
authors.initials: E
authors.lastname: Tabaraee
authors.forename: Junho
authors.initials: J
authors.lastname: Ahn
authors.forename: Akshay
authors.initials: A
authors.lastname: Jain
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology*