Prevalence of Urinary Tract Infection and Health Outcomes in Older Adults Undergoing Hip Surgery: A Prospective Study

Authors

  • Sureerat Mongkolpun Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
  • Inthira Roopsawang Assistant Professor, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
  • Suparb Aree-Ue Associate Professor, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2023.260330

Keywords:

Functional ability, Health outcomes, Hip fracture, Hip surgery, Infections, Older adults, Postoperative complications, Quality of life, Urinary tract infections

Abstract

Urinary tract infections are complications found mostly in older adults undergoing hip surgery. However, little is known about the impact of urinary tract infections on health at after post-hip fracture surgery, particularly in Thailand. This prospective study investigated the prevalence of urinary tract infections and their impact on length of stay, functional ability, re-admission, surgical site infections, and in-hospital mortality. The participants were 120 older adults undergoing hip surgery at four tertiary care hospitals in Bangkok, Thailand. Instruments for collection the data were the Demographic Data Questionnaire, Health Outcome Data Record Form—length of hospital stays, surgical site infections, re-admission, and in-hospital mortality, and the Hip Disability and Osteoarthritis Outcome Score. Data were analyzed using descriptive statistics and Firth’s logistic regression.
Results demonstrated that the prevalence of urinary tract infections was 28.32%. Significantly, older adults who developed urinary tract infections had a 2.88-fold increased the risk of impaired functional ability four weeks after surgery and a 3.21-fold increased the risk of re-admission to the hospital compared to those without urinary tract infections. Findings suggest that nurses should continually evaluate urinary tract infections and related factors from admission to post-discharge, as urinary tract infections profoundly affect health outcomes. Strict compliance with guidelines or strengthening post-acute care services to prevent urinary tract infections and its consequences is recommended to promote and restore health, especially functional ability in older adults undergoing hip surgery.

References

Bliemel C, Buecking B, Hack J, Aigner R, Eschbach DA, Ruchholtz S, et al. Urinary tract infection in patients with hip fracture: an underestimated event? Geriatr Gerontol Int. 2017;17(12):2369–75.

Goh EL, Lerner RG, Achten J, Parsons N, Griffin XL, Costa PML. Complications following hip fracture: results from the World Hip Trauma Evaluation cohort study. Injury. 2020;51(6):1331-6. doi: 10.1016/j.injury.2020. 03.031.

Folbert EC, Hegeman JH, Gierveld R, Van Netten JJ, Velde D van der, Ten Duis HJ, et al. Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch Orthop Trauma Surg. 2017;137(4):507–15.

Crouser N, Malik AT, Phieffer LS, Ly TV, Khan SN, Quatman CE. Urinary tract infection (UTI) at time of geriatric hip fracture surgery increases the risk of experiencing adverse 30-day outcomes. J Clin Orthop Trauma. 2019;10(4):774–8.

Kwak DK, Oh CY, Lim JS, Lee HM, Yoo JH. Would early removal of indwelling catheter effectively prevent urinary retention after hip fracture surgery in elderly patients? J. Orthop Surg Res. 2019;14(1):315. doi: 10.1186/s13018-019-1360-1.

Shih WY, Chang CC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Incidence and risk factors for urinary tract infection in an elder home care population in Taiwan: a retrospective cohort study. Int J Environ Res Public Health. 2019;16(4):566. doi: 10.3390/ijerph1604 0566.

Yassa RR, Khalfaoui MY, Veravalli K, Evans DA. Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery?a retrospective analysis. J R Soc Med. 2017;8(3): 2054270416675083. doi: 10.1177/2054270416675083.

Wiedl A, Förch S, Fenwick A, Mayr E. Incidence, risk-factors and associated mortality of complications in orthogeriatric co-managed inpatients. Geriatr Orthop Surg Rehabil. 2021; 12:2151459321998314. doi: 10.1177/2151459321998314.

Cheung CL, Ang SB, Chadha M, Chow ESL, Chung YS, Hew FL, et al. An updated hip fracture projection in Asia: the Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia. 2018;4(1):16–21.

Chen YP, Kuo YJ, Liu CH, Chien PC, Chang WC, Lin CY, et al. Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study. Ther Adv Musculoskelet Dis.

; 13:1759720X211028360. doi: 10.1177/1759720X211028360.

Remily EA, Mohamed NS, Wilkie WA, Mahajan AK, Patel NG, Andrews TJ, et al. Hip fracture trends in America between 2009 and 2016. Geriatr Orthop Surg Rehabil. 2020; 11:2151459320929581. doi: 10.1177/2151459320929581.

Sheikh HQ, Hossain FS, Khan S, Usman M, Kapoor H, Aqil A. Short-term risk factors for a second hip fracture in a UK population. Eur J Orthop Surg Traumatol. 2019;29(5):1055–60.

Chiang MH, Lee HJ, Kuo YJ, Chien PC, Chang WC, Wu Y, et al. Predictors of in-hospital mortality in older adults undergoing hip fracture surgery: a case–control study. Geriatr Orthop Surg Rehabil. 2021;12:21514593211044644. doi: 10.1177/21514593211044644.

Araiza-Nava B, Méndez-Sánchez L, Clark P, Peralta-Pedrero ML, Javaid MK, Calo M, et al. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: a systematic review. Osteoporos Int. 2022;33(7):1429–44.

Crespi Z, Ismail A, Awad ME, Hasan AI, Irfan FB, Jaffar M, et al. Hospital-acquired conditions: a review of classical and novel risk factors following total hip and knee arthroplasties. JBJS Rev. 2021;9(7). doi: 10.2106/JBJS.RVW.20.00240.

Saadat GH, Alsoof D, Ahmad B, Butler BA, Messer TA, Bokhari F. Incidence, risk factors and clinical implications of postoperative urinary tract infection in geriatric hip fractures. Injury. 2022;53(6):2158–62.

Wagenlehner FME, Bjerklund Johansen TE, Cai T, Koves B, Kranz J, Pilatz A, et al. Epidemiology, definition and treatment of complicated urinary tract infections. Nat Rev Urol. 2020;17(10):586–600.

Wong BTH, Kan SCF, Lo AHK, Ho LY, Kan RWM, Lai C. Asian guidelines for UTIs & STIs UTI section: complicated UTIs with neurogenic bladder. J Infect Chemother. 2022; 28(1):6–9.

Rønfeldt I, Larsen LK, Pedersen PU. Urinary tract infection in patients with hip fracture. Int J Orthop Trauma Nurs. 2021;41:100851. doi: 10.1016/j.ijotn.2021.100851.

Kaur R, Kaur R. Symptoms, risk factors, diagnosis and treatment of urinary tract infections. Postgrad Med J. 2021;97(1154):803–12.

Liu SY, Li C, Zhang PX. Enhanced recovery after surgery for hip fractures: a systematic review and meta-analysis. Perioper Med (Lond). 2021;10(1):31. doi: 10.1186/s13741-021-00201-8.

Werneburg GT. Catheter-asociated urinary tract infections: current challenges and future prospects. Res Rep Urol. 2022;14:109–33.

Rodriguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context. 2020;9:2020-4-13. doi:10. 7573/dic.2020-4-13.

Garcia-Bustos V, Escrig AIR, López CC, Estellés RA, Jerusalem K, Cabañero-Navalón MD, et al. Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance. Sci Rep. 2021; 11(1):11927. doi: 10.1038/s41598-021-90949-2.

Fischer K, Trombik M, Freystätter G, Egli A, Theiler R, Bischoff-Ferrari HA. Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis. Osteoporos Int. 2019;30(7):1371–81.

Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019;20(1):568. doi: 10.1186/s12891-019-2950-0.

Meyer AC, Eklund H, Hedström M, Modig K. The ASA score predicts infections, cardiovascular complications, and hospital readmissions after hip fracture - a nationwide cohort study. Osteoporos Int. 2021;32(11):2185-92.

Craxford S, Marson BA, Nightingale J, Ikram A, Agrawal Y, Deakin D, et al. Deep infection after hip hemiarthroplasty: risk factors for infection and outcome of treatments. Bone Jt Open. 2021;2(11):958-65.

Pollmann CT, Dahl FA, Røtterud JHM, Gjertsen JE, Årøen A. Surgical site infection after hip fracture - mortality and risk factors: an observational cohort study of 1,709 patients. Acta Orthop. 2020;91(3):347–52.

Ferris H, Brent L, Martin J, Crowley P, Coughlan T. 26 predictors of in-hospital mortality post hip fracture: what really matters? Age Ageing. 2019;48: iii17–65.

Suparb Aree-Ue, Phichpraorn Youngcharoen. The 6-item cognitive function test-Thai version: psychometric property testing. Rama Nurs J. 2020;26(2):188–202. (in Thai)

Burmeister E, Aitken LM. Sample size: how many is enough? Aust Crit Care. 2012;25(4):271–4.

Brooke P, Bullock R. Validation of a 6-item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999;14(11):936–40.

Rowe TA, Juthani-Mehta M. Diagnosis and management of urinary tract infection in older adults. Infect Dis Clin North Am. 2014;28(1):75–89.

Department of Disease Control Ministry of Public Health. Nosocomial infection diagnosis guideline. Aksorn Graphic and Design Publishing; 2018.

Lyman S, Lee YY, Franklin PD, Li W, Mayman DJ, Padgett DE. Validation of the HOOS, JR: a short-form hip replacement survey. Clin Orthop Relat Res. 2016;474(6):1472–82.

Parvizi J, Koo KH. Should a urinary tract infection be treated before a total joint arthroplasty? Hip Pelvis. 2019;31(1):1–3.

Malik AT, Quatman CE, Phieffer LS, Ly TV, Wiseman J, Khan SN. The impact of metabolic syndrome on 30-day outcomes in geriatric hip fracture surgeries. Eur J Orthop Surg Traumatol. 2019;29(2):427-33.

Downloads

Published

2022-12-14

How to Cite

1.
Sureerat Mongkolpun, Inthira Roopsawang, Suparb Aree-Ue. Prevalence of Urinary Tract Infection and Health Outcomes in Older Adults Undergoing Hip Surgery: A Prospective Study. PRIJNR [Internet]. 2022 Dec. 14 [cited 2024 Oct. 8];27(1):19-33. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/260330

Issue

Section

Original paper