US09 - Risk Factors and Outcomes for Postoperative Urinary Tract Infection After Partial and Radical Nephrectomy

Primary Presenter(s)

KL

Kimberly C. Lince, n/a

Student
University of the Incarnate Word
San Antonio, Texas, United States

Researcher(s)

Young Son, DO

PGY 3
Jefferson New Jersey
Jefferson New Jersey
Philadelphia, PA, United States
BF

Benjamin Fink

Rowan University
n/a, New Jersey, United States
SS

Scott Serpico, n/a

Philadelphia College of Osteopathic Medicine
Philidelphia, Pennsylvania, United States
VD

Virgil K. DeMario, n/a

University of Incarnate Word
San Antonio, Texas, United States
TM

Thomas Mueller, MD

Program Director- Urology
Jefferson Health New Jersey
n/a, New Jersey, United States

Introduction/Purpose: The incidence of kidney cancer increased at a rate of 2.4% per year between 1992 and 20151. This increase in detection of kidney cancer has been attributed to the increased utilization of cross sectional imaging and ultrasound2,3. Radical and partial nephrectomy are the primary treatments for solid renal masses as the chances of malignancy of such findings approaches 85%4. However, nephrectomy is not without risk. The overall complication rates for partial and radical nephrectomy are estimated to be 20% and 14%5. Specifically, the approximate estimated risks of postoperative urinary tract infection (UTI) and wound infection are 1.6% and 2.3%, respectively, for patients undergoing radical or partial nephrectomy. Patients with these, among other, postoperative complications have been associated with an increase in the overall postoperative reintervention, readmission, and 30- day mortality rates6. Current literature provides the rates of postoperative complications; however, there is a paucity of discussion surrounding independent variables associated with the infectious complications after nephrectomy. The availability of the novel 2019 and 2020 nephrectomy targeted participant use data file from the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) has the potential to address this gap in the literature. The goal of this ACS NSQIP database analysis is to identify independent risk factors associated with postoperative infections after radical and partial nephrectomy. Our secondary objective is to identify the postoperative variables associated with postoperative UTI.

Methods or Case Description: The ACS NSQIP is a health insurance portability and accountability act (HIPAA) compliant data file containing patient cases from 706 participating hospital institutions. This retrospective study focused on radical and partial nephrectomy cases in the NSQIP data set. A total of 14,186 patients who underwent partial or radical nephrectomy were initially evaluated. Inclusion criteria included a postoperative diagnosis of Malignant neoplasm of right kidney, except renal pelvis, Malignant neoplasm of kidney, except renal pelvis, Malignant neoplasm of left kidney, except renal pelvis, Malignant neoplasm of unspecified kidney, except renal pelvis, and Personal history of other malignant neoplasm of kidney (n=8391). Patients without data available for a postoperative diagnosis were excluded. The patients were then sub grouped to those that had a postoperative UTI and those who did not. The two groups were then compared. For categorical variables, Pearson chi square tests were performed. For continuous variables, mean+/-SD were presented and t-test analysis was performed. A univariate and multivariate analysis was performed with significant variables from the basic statistical analysis to predict the independent factors associated with UTI. Statistical analysis was accepted at p< 0.05.

Outcomes: There were 119 (1.4%) postoperative UTIs among a total of 8,391 patients that underwent nephrectomy for kidney cancer. Of the 119 patients, 22 patients underwent partial nephrectomy while 97 underwent radical nephrectomy. The UTI cohort was older, had higher male predominance, and an increased frequency of prior pelvic surgery, neoadjuvant chemotherapy, preoperative oral antibiotic treatment, and hypertension requiring medication (Table 1). With regard to postoperative outcomes, the infection group had greater transfusion requirements, operative time, rates of post operative sepsis, pneumonia and pulmonary embolism, discharge to care facility, unplanned readmission, and unplanned reoperation (Table 2). On multivariate logistic regression analysis of the UTI cohort, there again was male predominance, higher frequency of prior pelvic surgery, neoadjuvant chemotherapy, indication for preoperative oral antibiotic therapy, hypertension requiring medication, postoperative sepsis, pneumonia, and unplanned readmission (Table 3). Of note, transfusion requirement and unplanned reoperation were significant in basic statistics and univariate analysis, however was insignificant in multivariate analysis suggesting confounding factors.

Conclusion: As the incidence of kidney cancer has increased in recent decades, so too has the frequency with which radical and partial nephrectomies are performed. While these surgeries are an integral component in the management of renal malignancies, they are associated with significant postoperative risk profiles. Although current literature reports the rate of postoperative nephrectomy UTIs, independent variables associated with the UTIs have not been definitively explored. Our primary objective was to identify the associated variables that influence postoperative UTIs after radical and partial nephrectomy. Significant preoperative independent variables associated with postoperative nephrectomy UTIs were increasing age, male gender, prior pelvic surgery, neoadjuvant chemotherapy, preoperative oral antibiotic prep, hypertension requiring medication. Postoperatively, patients with UTI were independently associated with sepsis, pneumonia occurrence, and unplanned readmission. By distinguishing these factors, we intend to increase awareness as well as potentially decrease these factors in order to predominantly reduce the rates of this aforementioned nephrectomy complication.