Abstract
Introduction
Pre-operative urine screening is accepted practice during pre-operative assessment in elective orthopaedic practice. There is no evidence surrounding the benefits, effects or clinical outcomes of such a practice.
Methods
A series of 558 patients undergoing elective admission were recruited during pre-assessment for surgery and were screened for UTIs according to a pre-existing trust protocol. All patients had their urine dipstick tested and positive samples were sent for culture and microscopy. Patients with a positive urine culture were treated prior to surgery and were admitted to the elective centre where strict infection control methods were implemented. The patients were followed up after their surgery and divided into three clinical groups: uneventful surgery; Suspected wound infection; Confirmed wound infection
Results
85% of dipsticks tested were positive, while only 7% of the urine samples were culture positive. Over 36% of patients with a pre-operative urinary tract infection showed some form of post-operative delayed wound healing or confirmed infection, versus 16% in the other sub-group, giving a relative risk of wound complications of 2:1. There was also an increase in confirmed infection in oozing wounds; 53% positive wound swabs versus 37% in those without a cultured urinary tract infection. A chi-squared analysis yielded a value of 6.07, giving a p value <0.02. There is therefore a statistically significant correlation between a positive urine culture and poor surgical outcome.
Conclusion
Pre-operative urine screening and culture has a demonstrable correlation with post-operative surgical outcome. In the light of this study pre-operative urine culture should be mandatory for all pre-operative orthopaedic patients. It should be recognised that patients who present to pre-admission with a UTI are a high risk subgroup for wound infection post-operatively and this should be taken into account when consenting patients for surgery.
