Incidence, Risk Factors and Outcomes of Urinary Tract Infections among Patients Undergoing Thyroidectomy: Insights from the ACS-NSQIP

Abstract

Introduction Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy.

Objective This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy.

Methods This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019. Multivariable logistic regression models were used to identify risk factors and associations of UTIs with postoperative morbidity and mortality.

Results In a cohort of 180,373 identified thyroidectomy patients, 0.28% contracted a UTI. Significant risk factors associated with UTIs included age > 60 years (adjusted odds ratio [OR] 2.187, 95% confidence interval [CI] 1.618–2.956), female gender (OR 1.767, 95% CI 1.372–2.278), American Society of Anesthesiologists (ASA) Classification 3 to 5 (OR 1.463, 95% CI 1.185–1.805), partially (OR 4.267, 95% CI 2.510–7.253) or totally dependent functional health status (OR 9.658, 95% CI 4.170–22.370), pulmonary disease (OR1.907, 95% CI 1.295–2.808), chronic steroid therapy (OR 1.649, 95% CI 1.076–2.527), inpatient procedure (OR 1.507, 95% CI 1.251–1.814), and operative time > 150 minutes (OR 1.449, 95% CI 1.027–2.044). Additionally, UTIs were independently associated with postoperative complications, including pulmonary, vascular, or cardiac complication; stroke; acute renal failure; infectious complications; sepsis; septic shock; pneumonia; prolonged length of stay; unplanned reoperation; and mortality.

Conclusion While UTIs are rare after thyroidectomy, they carry a significant burden on patient outcomes. Preoperative optimization of comorbidities and reducing operative times may help mitigate the risk of UTIs. Optimized care for postoperative UTI patients is also recommended to prevent complications and improve outcomes.

Keywords

thyroidectomy - urinary tract infection - morbidity - mortality

Disclaimer

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Authors' Contributions

UW conceptualized the study. UW, HI, and SAA designed the study. UW and NA drafted the protocol. SAA performed statistical analyses. UW, ZZF, WA, and AAC drafted the initial version of the manuscript which was reviewed and edited by all authors. All authors approved the final version of the manuscript to be published.

Data Statement

Data was obtained through the ACS-NSQIP database and is used with the permission of The American College of Surgeons.

Publikationsverlauf

Eingereicht: 31. August 2023

Angenommen: 03. Juni 2024

Artikel online veröffentlicht:
10. Januar 2025

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