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Reducing urinary tract infection in female pelvic surgery: A retrospective cohort study
Gurkiran K Mann1, Nicole A Koenig2, Terry Lee3
1Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
Insights
Implementing a clinical bundle significantly reduced urinary tract infection (UTI) rates and hospital stays for patients undergoing pelvic reconstructive surgery. This strategy improved patient outcomes and shortened recovery times.
Area of Science:
- Urology
- Infectious Disease Prevention
- Surgical Outcomes
Background:
- Urinary tract infections (UTIs) are a common complication following clean-contaminated pelvic reconstructive surgery.
- Optimizing perioperative care is crucial for reducing infection rates and improving patient recovery.
Purpose of the Study:
- To compare the incidence of UTIs in inpatients before and after the implementation of a clinical bundle for clean-contaminated pelvic reconstructive surgery.
- To evaluate the impact of the bundle on postoperative hospital stay.
Main Methods:
- A retrospective cohort study was conducted comparing pre- and post-bundle implementation periods (September 2019 - December 2021).
- The clinical bundle included preoperative UTI screening, early catheter removal, and daily cranberry extract.
- UTI was defined by symptomatic presentation with a positive urine culture.
Main Results:
- Postoperative UTI rates decreased significantly from 17.6% pre-bundle to 6.5% post-bundle (P=0.01).
- The adjusted odds ratio for UTI post-bundle was 0.35 (P=0.045), indicating a reduced likelihood of infection.
- Early discharge on postoperative day one increased significantly in the post-bundle group (76.3% vs. 37.7%, P<0.001).
Conclusions:
- A comprehensive clinical bundle effectively reduces UTI rates in patients undergoing pelvic reconstructive surgery.
- The implemented bundle also contributes to a shorter hospital stay, enhancing patient recovery and hospital resource utilization.
Objective:
To compare prebundle versus postbundle implementation urinary tract infection (UTI) rates among inpatients within 6 weeks of clean-contaminated pelvic reconstructive surgery.
Methods:
The authors conducted a retrospective cohort study from September 2019 to December 2021 at a tertiary hospital. The bundle strategy included the following: universal preoperative UTI check with treatment if positive, replacing prolonged postoperative voiding trials on the ward with earlier discharge and indwelling catheter removal by a nurse continence advisor the next day, and daily cranberry extract for 6 weeks postoperatively. UTI was defined as positive urine culture (≥100 000 colony-forming unit per mL) in a symptomatic patient. Data analysis involved hypothesis testing and logistic regression.
Results:
The authors reviewed 132 postbundle inpatient charts and retained 93 for analyses. The results were compared with 204 prebundle inpatient charts. The rate of postoperative UTI decreased from 17.6% in the prebundle group to 6.5% after bundle implementation (P = 0.01). The adjusted odds ratio for postbundle versus prebundle likelihood of UTI was 0.35 (95% confidence interval, 0.13-0.98; P = 0.045). Significantly more postbundle patients compared with prebundle patients were discharged home on the first day postoperatively (76.3% vs. 37.7%, P < 0.001).
Conclusions:
A clinical bundle can significantly decrease both UTI rates and hospital stay after pelvic reconstructive surgery.
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