Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery
Objective: To assess the impact of cessation of screening urine cultures on surgical site infection (SSI) incidence in clinical practice. Patients and Methods: Our study included patients undergoing hip replacement, knee replacement, spinal fusion, and laminectomy 12 months before (preintervention)...
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2020-04-01
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doaj-2555ad07c1aa4bb0b3abc8b4b8e116662020-11-25T02:29:23ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482020-04-0142126131Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal SurgeryWalter C. Hellinger, MD0Daniela A. Haehn, MD1Michael G. Heckman, MS2Joan M. Irizarry Alvarado, MD3Wendelyn Bosch, MD4Sher-Lu Pai, MD5Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL; Correspondence: Address to Walter C. Hellinger, MD, Division of Infectious Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224Department of Urology, Mayo Clinic, Jacksonville, FLDivision of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FLDivision of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FLDivision of Infectious Diseases, Mayo Clinic, Jacksonville, FLDepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FLObjective: To assess the impact of cessation of screening urine cultures on surgical site infection (SSI) incidence in clinical practice. Patients and Methods: Our study included patients undergoing hip replacement, knee replacement, spinal fusion, and laminectomy 12 months before (preintervention) and after (postintervention) cessation of preoperative screening urine cultures on June 1, 2017, at our institution. Urine cultures and urinalyses performed within 30 days before surgery during the 12 months before and after cessation were reviewed. SSI surveillance was performed in accordance with the methods of the National Healthcare Safety Network. Results: A total of 2754 patients were included (1286 preintervention and 1468 postintervention). In the preintervention period, 1141 urine cultures were performed, compared to 153 in the postintervention period; 35 and 6 episodes of asymptomatic bacteriuria were treated, respectively. The occurrence of SSI did not differ noticeably between time periods (1.2% vs 0.7%, P=.24), and quarterly incidences of SSI were unchanged. The rate of SSI was significantly lower in the postintervention period for laminectomy (3.0% vs 0.3%, P=.02). Conclusion: An 86.6% (153 vs 1141) reduction in screening urine cultures over a 12-month period was associated with a reduction of 988 unnecessary urine cultures, an 82.8% (6 vs 35) decline in inappropriate antibiotic treatment of asymptomatic bacteriuria, and no increase in SSI incidence after hip replacement, knee replacement, spinal fusion, or laminectomy procedures. No value of screening urine cultures before clean surgery was identified.http://www.sciencedirect.com/science/article/pii/S2542454820300400 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Walter C. Hellinger, MD Daniela A. Haehn, MD Michael G. Heckman, MS Joan M. Irizarry Alvarado, MD Wendelyn Bosch, MD Sher-Lu Pai, MD |
spellingShingle |
Walter C. Hellinger, MD Daniela A. Haehn, MD Michael G. Heckman, MS Joan M. Irizarry Alvarado, MD Wendelyn Bosch, MD Sher-Lu Pai, MD Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
author_facet |
Walter C. Hellinger, MD Daniela A. Haehn, MD Michael G. Heckman, MS Joan M. Irizarry Alvarado, MD Wendelyn Bosch, MD Sher-Lu Pai, MD |
author_sort |
Walter C. Hellinger, MD |
title |
Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery |
title_short |
Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery |
title_full |
Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery |
title_fullStr |
Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery |
title_full_unstemmed |
Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery |
title_sort |
improving value of care: cessation of screening urine culture prior to orthopedic and spinal surgery |
publisher |
Elsevier |
series |
Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
issn |
2542-4548 |
publishDate |
2020-04-01 |
description |
Objective: To assess the impact of cessation of screening urine cultures on surgical site infection (SSI) incidence in clinical practice. Patients and Methods: Our study included patients undergoing hip replacement, knee replacement, spinal fusion, and laminectomy 12 months before (preintervention) and after (postintervention) cessation of preoperative screening urine cultures on June 1, 2017, at our institution. Urine cultures and urinalyses performed within 30 days before surgery during the 12 months before and after cessation were reviewed. SSI surveillance was performed in accordance with the methods of the National Healthcare Safety Network. Results: A total of 2754 patients were included (1286 preintervention and 1468 postintervention). In the preintervention period, 1141 urine cultures were performed, compared to 153 in the postintervention period; 35 and 6 episodes of asymptomatic bacteriuria were treated, respectively. The occurrence of SSI did not differ noticeably between time periods (1.2% vs 0.7%, P=.24), and quarterly incidences of SSI were unchanged. The rate of SSI was significantly lower in the postintervention period for laminectomy (3.0% vs 0.3%, P=.02). Conclusion: An 86.6% (153 vs 1141) reduction in screening urine cultures over a 12-month period was associated with a reduction of 988 unnecessary urine cultures, an 82.8% (6 vs 35) decline in inappropriate antibiotic treatment of asymptomatic bacteriuria, and no increase in SSI incidence after hip replacement, knee replacement, spinal fusion, or laminectomy procedures. No value of screening urine cultures before clean surgery was identified. |
url |
http://www.sciencedirect.com/science/article/pii/S2542454820300400 |
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