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Comprehensive assessment of risk factors for postoperative urinary tract infection following pediatric pyeloplasty
Nikhil V Batra1, Kate H Adaniya1, Ashorne K Mahenthiran2
1Division of Pediatric Urology, Riley Hospital for Children Indiana University School of Medicine, 535 N Barnhill Dr, Indianapolis, IN, 46202, USA.
Insights
Female patients and those with a history of urinary tract infection (UTI) face a higher risk of postoperative UTI after pediatric pyeloplasty. Understanding these risk factors is crucial for informed patient counseling.
Area of Science:
- Pediatric Urology
- Surgical Outcomes Research
Background:
- Pyeloplasty is a common procedure for pediatric ureteropelvic junction obstruction.
- Practices for perioperative management and postoperative drainage vary.
- Identifying risk factors for postoperative complications is essential for improving patient care.
Purpose of the Study:
- To assess risk factors for postoperative urinary tract infection (UTI) following pediatric pyeloplasty.
- To evaluate the impact of perioperative management and drainage strategies on UTI risk.
Main Methods:
- Retrospective review of electronic health records for 295 patients undergoing open or robotic pyeloplasty (2018-2023).
- Evaluation of demographics, perioperative characteristics, and symptomatic postoperative UTIs within 30 days.
- Statistical analysis including univariate and multivariate models to identify significant predictors.
Main Results:
- Four percent (11/295) of patients developed febrile UTI post-surgery.
- Female gender and a history of UTI were significant risk factors on univariate analysis.
- Female gender remained the sole significant predictor (OR 4.5, p=0.026) on multivariate analysis; drainage methods were not associated with increased risk.
Conclusions:
- Female gender and prior UTI history are significant predictors of postoperative UTI after pediatric pyeloplasty.
- These findings can aid in preoperative counseling for parents.
- Further research may explore targeted preventative strategies based on identified risk factors.
Purpose:
Variable patterns of perioperative management and postoperative drainage following pyeloplasty are utilized at our institution. We reviewed our patient population and practices to assess risk factors for postoperative urinary tract infection (UTI) following pediatric pyeloplasty.
Methods:
Electronic health records of patients who underwent open or robotic pyeloplasty from 2018 to 2023 were retrospectively reviewed. Demographics, perioperative characteristics, and postoperative UTI within 30 days were evaluated. Postoperative UTI was defined as symptomatic and requiring antibiotic therapy. Patients with concurrent conditions elevating risk for UTI and asymptomatic patients with positive cultures were excluded. Univariate and multivariate statistical analysis were performed.
Results:
295 patients underwent pyeloplasty with median age of 13 months (IQR 3-91). Eleven (4%) patients had febrile UTI within 30 days of surgery. On univariate analysis, female gender (p = 0.007) and UTI history (p = 0.045) were significantly associated with risk for postoperative UTI. On multivariate analysis, only female gender (OR 4.5, 95% CI 1.2-17.3, p = 0.026) remained significantly associated. No other variables, including type of postoperative drainage and nephrostomy tube drainage prior to surgery, were associated with increased risk.
Conclusion:
Female gender and UTI history were significant predictors of postoperative UTI following pediatric pyeloplasty. This knowledge may help inform parents during preoperative counseling.
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