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Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery

El-Nashar, Sherif A., MBBCh, PhD; Singh, Ruchira, MD, MS; Schmitt, Jennifer J., DO, MS; Leon, Daniel Carranza, MD; Arora, Chetna, MD; Gebhart, John B., MD, MS; Occhino, John A., MD, MS

doi: 10.1097/AOG.0000000000002931
Original Research: PDF Only

OBJECTIVE: To report rates and identify risk factors for urinary tract infection (UTI) after hysterectomy for benign conditions or combined with pelvic reconstructive surgery.

METHODS: This is a cohort study that included women who underwent hysterectomy either for benign gynecologic conditions or hysterectomy combined with pelvic reconstructive surgery from January 1, 2012, through June 30, 2014, at a single institution. The primary outcome was UTI within 8 weeks of surgery. Logistic regression modeling was used to develop a model for predicting UTI after surgery.

RESULTS: Of 1,156 women included in the study, 136 (11.8%, 95% CI 10.0–13.8) developed UTI within 8 weeks. Women who underwent hysterectomy for a benign gynecologic condition that was not combined with pelvic reconstructive surgery had an overall UTI rate of 7.3% (95% CI 5.6–9.3) vs 21.7% (95% CI 17.6–26.4) after hysterectomy combined with pelvic reconstructive surgery. After adjusting for hormone therapy use, the following were independent variables associated with postoperative UTI: premenopausal status with an adjusted odds ratio (OR) of 1.80 (95% CI 1.11–2.99), anterior vaginal wall prolapse with an adjusted OR of 4.39 (95% CI 2.77–6.97), and postvoid residual greater than 150 mL with an adjusted OR of 2.38 (95% CI 1.12–4.36). Using this model, postoperative UTI rates ranged from 4.3% to 59.4% with high postvoid residual and presence of anterior prolapse having the strongest association.

CONCLUSION: There are wide variations in the rate of UTI after hysterectomy for begin disease including pelvic reconstructive surgery. These variations can be explained with a model based on available preoperative data.

There are wide variations in the rates of urinary tract infection after hysterectomy, and most of this variation can be explained by available preoperative data.

Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.

Corresponding author: John A. Occhino, MD, MS, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905; email: occhino.john@mayo.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 18, 2018

Received in revised form July 19, 2018

Accepted August 16, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.