1. Thank you Dr. ______.

This afternoon, we will be discussing Urinary Tract

Infections in Colorectal surgery and procedural specific risk factors for UTIs
following colorectal operations.
2. I have Nothing to Disclose
3. Catheter associated urinary tract infections are the most common hospital
acquired infection.
Centers for Medicare and Medicaid Services will no longer reimburse hospitals
for costs associated with the development of Hosipital acquired CAUTIs- thus it
is imperitive to identify patients at high risk and implement prevention
strategies aimed at reducing the health and financial burden to both the patient
and hospitals. UTIs have been shown to increase hospital length of stay and most
importantly postoperative UTI increases in-house mortality.
o Previous literature has shown patients undergoing colorectal surgery are at
increased risk for UTIs . However, there is not much literature out there and the
risk factors not well defined,
4. Hypothesis: We hypothesized that certain procedures would have an increased
risk. A previous study has show SSI to be less in Right vs. Left. We hypothesize
that APR would likely be highest because of instrumentation and operating in
the perineum. And that the more instrumentation and tissue handling as well as
manipulation of stapling devices would be associated with increased incidence.
o The purpose of our study was to determine if the approach of colon resection,
anatomic location, or creation of an ostomy influence the likelihood of acquiring
a UTI
5. We obtained the data files from the NSQIP for the calendar years 2005-2012. We
included all patients undergoing Colorectal Surgery and excluded trauma
patients and patients less than 18 years old.
o Using the CPT codes we stratified colorectal procedures by anatomic location,
open vs laparoscopic procedures, as well as creation of an ostomy. We extracted
data according to the CPT codes for right sided colectomy, left-sided colectomy,
low anterior resection, and abdominoperineal resection. In addition to specific
procedure, gender, BMI, ASA class, smoking history, and occurrence of UTI were
analyzed.
o The association of anatomic region, creation of an ostomy, open vs lap and the
demographic factors (gender, ASA, and BMI) was assessed using chi-squared test
or t-test/anova for discrete and continuous variables, respectively. The
association of anatomic region, ostomy, open vs lap, demographic factors and
occurrence of UTI was assessed in the same way. A multivariate logistic
regression for occurrence of UTI including the surgical and demographic
variables was built.
6. There was a total of 134,149 patients included in the analysis. 69,263, or a little
over half of these(52%) were females. Of these, there was close to 5000 (4,776)
patients with a UTI or a rate of three and a half percent. (3.55%)
7. Now, looking at our results: As would be expected, incidence of Urinary tract
infection increased by ASA score. Going from 2% with and ASA of 1 to over 12 %
with an ASA of 5.
o Consistent with other literature, Female gender was more likely to develop a
UTI. Incidence amongst female was almost double that of males.
8. UTI rates significantly increased as the anatomic region of resection advanced
proximal to distal (right 2.9%, left 3.2%, low anterior resection 4.1%,
abdominoperineal resection 6.8%, p-value <0.00001). Open operations (4.4% vs.
2.5%, p-value <0.00001) and creation of an ostomy had an incidence nearly double
those without (5.5% vs. 2.9%, p-value <0.00001) had a significantly higher rate of
UTI.
9. Multivariate analysis identified anatomic location, operative approach, ostomy
creation, ASA classification and gender as significant independent risk factors for
UTI. The odds ration increases to nearly 1.6 for APRs as well as creation of an
ostomy.
o BMI and smoking was not included d/t space limitations. Smokers and BMI
greater than 30 had a slightly increased risk of UTI but were not found to be a
statistically significant independent risk factor.
10. In summary. UTIs are common. They are more common following colorectal
procedures. Our data show that anatomic location, surgical approach, and
ostomy creation are procedural specific risk factors that affect prevalence of UTI
in colorectal surgery.
o Our speculations include: More distal procedures have increased
instrumentation and operating in the perineum . The further distal, more likely
to have urinary retention Unfortunetly one of the limitations: Unknown length of
catheter days.
o Laparoscopic surgery- have less tissue handling intraoperatively,
postoperatively less pain, early ambulation, possibly quicker removal of catheter
o It is likely that ostomy creation is a hygiene issue...

11. CONCLUSIONS: Future prospective trials are needed. The proper preventative
measures are needed to identify intraoperative and postoperative strategies to
reduce UTI according to those at increased risk. Although more research needs
to be done, recognizing risk factors creates an opportunity to improve surgical
outcomes for patients and reduce costs.
12. Thank you for the opportunity to present our data, and the privilege of the
podium. Any Questions?