Urinary Tract Infections Before Surgery Elevate Readmission Odds in Hysterectomy Patients: Study Shows

"Although UTIs did not significantly increase the overall rate of postoperative complications, the findings suggest a notably higher risk of readmission within 30 days following the procedure," the researchers reported.

Preoperative urinary tract infections have been linked to adverse surgical outcomes in specific patient groups. In this context, Laura Douglass, Section of Minimally Invasive Gynecologic Surgery, University of Chicago, Chicago, IL, USA, and colleagues aimed to evaluate the impact of a preoperative UTI on the likelihood of 30-day postoperative complications among women undergoing benign hysterectomy.

For this purpose, the researchers conducted a retrospective cohort study using data from the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. They identified surgeries based on CPT codes and categorized surgical indications using ICD-9 and ICD-10 codes. A preoperative urinary tract infection was defined as a symptomatic UTI in patients who had not yet started or were undergoing antibiotic treatment at the time of surgery.

The primary outcome measured was the occurrence of any postoperative complication within 30 days. To compare groups, statistical analyses such as the Chi-square and Fisher’s exact tests were used for categorical variables, while the Mann-Whitney U test was applied for continuous variables.

Key Findings:

• Patients with preoperative UTI were generally older and had higher rates of ASA physical status class 3 or 4.
• The incidence of vaginal hysterectomy and surgical indications such as pain or prolapse was greater among those with UTI.
• Operative time and reoperation rates were significantly higher in the UTI group.
• Overall, 5.6% of all patients undergoing benign hysterectomy experienced a postoperative complication within 30 days.
• Patients with a preoperative UTI had a higher 30-day complication rate (8.2%) compared to those without UTI (5.6%).
• After adjusting for confounding factors, preoperative UTI was no longer independently associated with overall 30-day complications.
• However, patients with UTI had nearly four times the odds of readmission within 30 days (adjusted OR 3.98).

The researchers concluded that although a preoperative urinary tract infection did not significantly impact the overall risk of postoperative complications, it was strongly linked to a nearly fourfold increase in 30-day readmission rates following benign hysterectomy. This highlights the importance of identifying and addressing UTIs before surgery as a potentially modifiable factor to improve surgical outcomes.

Reference:

Douglass, L., Ashmore, S., Shi, J., Dai, J., Ryles, H., Burgard, I., & Mueller, M. G. (2025). Impact of preoperative urinary tract infection on perioperative outcomes following benign hysterectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 311, 114019. https://doi.org/10.1016/j.ejogrb.2025.114019