Risk Factors and Consequences of Postoperative Urinary Tract Infections in Patients with Traumatic Cervical Cord Injury: A Retrospective Analysis

Abstract

Introduction: There is a lack of research on the relationship between cervical spinal cord injury (SCI) surgery and symptomatic urinary tract infections (UTIs); hence, this study seeks to fill this critical knowledge gap in postoperative care. This study aims to identify the risk factors for UTIs in patients with traumatic cervical SCI.

Methods: We retrospectively analyzed 187 patients (mean age: 68 years) who underwent cervical SCI surgery between 2017 and 2021. Patients were categorized into UTI and non-UTI groups. Patients with recurrent UTIs were defined as the multiple-UTI group. Preoperative risk factors, including prognostic nutritional index (PNI; 10 × serum albumin [g/dL] + 0.005 × total lymphocyte count [/μL]), were assessed.

Results: Among 187 patients, 99 (52.9%) experienced a UTI within 90 days postoperatively. The majority of patients in the UTI group, that is, 92 patients (92.9%), had an indwelling catheter as urinary management at the time of the UTI. The UTI group faced higher rates of cardiopulmonary dysfunction, bacteremia, longer hospital stays, and increased medical costs. Multiple UTIs were associated with worse outcomes, including increased complications, longer hospital stays, and higher medical costs. PNI at 3 weeks and 4 weeks postoperatively in the multiple-UTI group was significantly lower than in the single-UTI and non-UTI groups. The American Spinal Injury Association impairment scale grade at admission was independently linked to initial UTI occurrence within 90 days after surgery when adjusting for confounding variables.

Conclusions: We found that 52.9% of patients experienced UTIs within 90 days postoperatively. The risk factors for UTI occurrence included the severity of paralysis, indwelling catheter, and poor improvement in the perioperative nutritional status. Early interventions with intermittent catheterization, appropriate antibiotics, and nutrition might be suggested for patients with severe cervical SCI and malnutrition.