Reduction of Postoperative UTI in Ambulatory Surgery Centers: Results of the NSQIP Ambulatory Surgery Pilot

Introduction: UTI after surgery is common and results in significant morbidity, mortality, and cost. Multiple studies demonstrate that NSQIP may help hospitals reduce postoperative UTIs; however, this has not previously been studied in the ambulatory surgery setting. Our healthcare system performs a high volume of complex surgical care within an integrated system of Ambulatory Surgery Centers (ASCs) and was the site of the NSQIP Ambulatory Surgery pilot. NSQIP outcomes data were used to identify higher than expected postoperative UTI rates in ASCs. UTIs were addressed using a multidisciplinary quality improvement program. Methods: Pilot data were examined to identify targets for quality improvement. A multidisciplinary team identified several interventions to decrease UTIs: reduction of unnecessary catheterizations; education on catheter placement; standardization of surgical prep; and implementation of postoperative urinary retention protocols. Retrospective analysis was performed to test whether these interventions decreased UTI occurrences. Results: During the 12-month study period, 2667 ambulatory surgery cases met criteria for NSQIP abstraction. Before implementation of the intervention, pilot data demonstrated a quarterly postoperative UTI rate of 2.65%, which was higher than expected compared with the January 2021 NSQIP Semi-Annual Report (SAR). Rates decreased after initiation of the intervention. Six months after full implementation of the intervention, the quarterly rate decreased to 0.96%. Conclusion: The NSQIP Ambulatory Surgery Pilot allowed identification of postoperative UTIs as a target for quality improvement. Intervention resulted in a reduction in postoperative UTI rates. This experience suggests NSQIP is effective in the ambulatory surgery setting.