title: Right Colectomy and Abdominal Perineal Resection for Cancer: Do Urinary Tract Infections Impact Outcomes?
abstract: BACKGROUND
  We aim to assess the patient factors and concomitant infectious outcomes associated with urinary tract infection (UTI) occurrence and the impact of UTI on length of stay (LOS), re-admission, and death in a colorectal surgical population.
  
  
  METHODS
  National Surgical Quality Improvement Program User Data for right colectomy and abdominal perineal resection (APR) procedures for cancer between 2006 and 2012 were analyzed. Concomitant infectious complications and timing of UTI diagnosis, inpatient versus outpatient, were considered.
  
  
  RESULTS
  We identified 7,615 right colectomies with 107 (1.4%) UTIs and 2,493 APRs with 88 (3.5%) UTIs (p < 0.001). On multivariable analysis and correction for other post-operative complications, UTI remained statistically correlated with prolonged LOS for right colectomy and APR (LOS increases of 59.0% and 37.4%, respectively, p < 0.001) but not death. Patients with a diagnosis of UTI after discharge showed significantly increased re-admission rates compared with UTI diagnosis before discharge (37.7% vs. 9.7%, p < 0.001).
  
  
  CONCLUSIONS
  After excluding deaths, outpatient UTI occurrences, and correcting for other infectious complications, UTI is associated with increased LOS but is not correlated with re-admission or death. Outpatient occurrence of UTI after hospital discharge is associated with a dramatic re-admission rate of 37.7%.
authors.affiliation: 1 Department of Surgery, The University of Iowa Carver College of Medicine , Iowa City, Iowa.
authors.forename: John G
authors.initials: JG
authors.lastname: Armstrong
authors.affiliation: 1 Department of Surgery, The University of Iowa Carver College of Medicine , Iowa City, Iowa.
authors.forename: Chien-Hsun
authors.initials: CH
authors.lastname: Li
authors.affiliation: 1 Department of Surgery, The University of Iowa Carver College of Medicine , Iowa City, Iowa.
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
authors.affiliation: 2 Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: John C
authors.initials: JC
authors.lastname: Byrn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000601:surgery; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology*
keywords: UTI; colorectal; hospital-acquired infection; length of stay; re-admission; surgery