title: Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859-5000, USA. alan.p.gehrich.mil@mail.mil.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Gehrich
authors.affiliation: Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, 96859, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Lustik
authors.affiliation: Department of Obstetrics and Gynecology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859-5000, USA.
authors.forename: Allen A
authors.initials: AA
authors.lastname: Mehr
authors.affiliation: Department of Obstetrics and Gynecology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859-5000, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Patzwald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*; D055815:Young Adult
keywords: Hysterectomy; Midurethral sling; Prolapse operations; TOT; TVT; Urinary tract infection