ORIGINAL CONTRIBUTIONS Predictors of Postoperative Urinary Tract Infection After Bariatric Surgery Zachary M. Helmen 1 & Melissa C. Helm 1 & Joseph H. Helm 1 & Alexander Nielsen 1 & Tammy Kindel 1 & Rana Higgins 1 & Jon C. Gould 1 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background In bariatric surgery patients, urinary tract infections (UTIs) are one of the most common postoperative infections. In this study, we sought to determine if preoperative patient factors and perioperative processes contribute to an increased risk of UTI. Methods A retrospective analysis was performed of patients who underwent bariatric surgery at a single institution between March 2012 and May 2016. Standard protocol was antibiotic prophylaxis with cefazolin. Patients with a penicillin allergy received clindamycin. Urinary catheters were placed selectively. A univariate and multivariate analyses were performed to determine risk factors for patients who developed a UTI within 30 days postoperatively. Results Six hundred ninety-four patients (82.7% female) underwent bariatric surgery in the study interval. UTIs were more common in females (4.9 vs. 1.7%, p = 0.12). On univariate analysis age, operative time, length of stay, urinary catheter place- ment, clindamycin prophylaxis, and revisional surgery were significantly correlated with UTI. A multivariate logistic regression model revealed the risk of UTI increased 5.38-fold [95% confidence interval (CI) 2.41–12.05] with clindamycin use, 6.37-fold [95% CI 2.22–18.18] with revision surgery, and 1.25-fold [95% CI 1.05–1.49] for every 5 years gained in age. Conclusions Older age, clindamycin prophylaxis, and revisional procedures are significantly associated with an increased rate of UTI following bariatric surgery. Several identified variables are modifiable risk factors and targets for a quality improvement initiative to decrease the rate of UTI in bariatric surgery patients. Keywords Bariatric surgery . Urinary tract infection (UTI) . SCIP Introduction Urinary tract infections (UTIs) are common, representing up to 40% of all nosocomial infections impacting 1.7 million patients annually [1]. Previous studies have demonstrated that up to 80% of UTIs are catheter-associated (CAUTI) and an average CAUTI event results in direct and indirect costs of $676 and $2386, respectively [2, 3]. In patients undergoing surgery at an American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) hospital, UTIs account for 16.9% of all post-discharge complications in bar- iatric surgery patients [4]. Our institution participates in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). In 2015, we received a semiannual report that identified our institution as a high outlier for Ball occurrence morbidity^ following both sleeve gastrectomy and laparo- scopic gastric bypass. Analysis determined that greater than 50% of recorded postoperative morbidities were UTIs. We sought to identify modifiable risk factors for UTI that could be addressed in an effort to decrease the rate of this postoper- ative morbidity. Materials and Methods Subjects were identified from our institution’s MBSAQIP da- tabase. Variables not available in the MBSAQIP database were captured from the electronic medical record. All patients Presented as a poster at the SAGES 2017 Annual Meeting, Houston, TX, March 2017 * Jon C. Gould jgould@mcw.edu 1 Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA Obesity Surgery https://doi.org/10.1007/s11695-017-3095-6