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Predictors of Postoperative Urinary Tract Infection After Bariatric Surgery

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Abstract

Background

In bariatric surgery patients, urinary tract infections (UTIs) are one of the most common postoperative infections. In this study, we sought to determine if preoperative patient factors and perioperative processes contribute to an increased risk of UTI.

Methods

A retrospective analysis was performed of patients who underwent bariatric surgery at a single institution between March 2012 and May 2016. Standard protocol was antibiotic prophylaxis with cefazolin. Patients with a penicillin allergy received clindamycin. Urinary catheters were placed selectively. A univariate and multivariate analyses were performed to determine risk factors for patients who developed a UTI within 30 days postoperatively.

Results

Six hundred ninety-four patients (82.7% female) underwent bariatric surgery in the study interval. UTIs were more common in females (4.9 vs. 1.7%, p = 0.12). On univariate analysis age, operative time, length of stay, urinary catheter placement, clindamycin prophylaxis, and revisional surgery were significantly correlated with UTI. A multivariate logistic regression model revealed the risk of UTI increased 5.38-fold [95% confidence interval (CI) 2.41–12.05] with clindamycin use, 6.37-fold [95% CI 2.22–18.18] with revision surgery, and 1.25-fold [95% CI 1.05–1.49] for every 5 years gained in age.

Conclusions

Older age, clindamycin prophylaxis, and revisional procedures are significantly associated with an increased rate of UTI following bariatric surgery. Several identified variables are modifiable risk factors and targets for a quality improvement initiative to decrease the rate of UTI in bariatric surgery patients.

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Authors and Affiliations

Authors

Contributions

1. Jon C. Gould was responsible for the concept and design of this study. Furthermore, Jon C. Gould takes full responsibility for the integrity of the work as a whole, from inception to published article.

2. Authors Zachary M. Helmen, Melissa C. Helm, and Alexander Nielsen were responsible for acquisition and interpretation of the data.

3. Authors Zachary M. Helmen, Melissa C. Helm, and Alexander Nielsen were responsible for analyzing and interpretation of the data in depth from the statistical point of view.

4. All authors were involved in drafting the manuscript and revising it critically for important intellectual content and have given final approval of the version to be published. Furthermore, all authors have participated sufficiently in the work to take public responsibility for its content.

Corresponding author

Correspondence to Jon C. Gould.

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Conflict of Interest

JG is a consultant for Torax Medical. The remaining authors declare that they have no competing interests.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

Does not apply.

Additional information

Presented as a poster at the SAGES 2017 Annual Meeting, Houston, TX, March 2017

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Helmen, Z.M., Helm, M.C., Helm, J.H. et al. Predictors of Postoperative Urinary Tract Infection After Bariatric Surgery. OBES SURG 28, 1950–1954 (2018). https://doi.org/10.1007/s11695-017-3095-6

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