Session: MP34: Infections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I
MP34-20: Severe Post-Operative Complications Are Rare in Patients With Urinary-Pubic Symphysis Fistulae and Pubic Bone Osteomyelitis (UPF-OM) Undergoing Extirpative Surgery; Data from the National Surgical Quality Improvement Program
Introduction: Patients with urinary-pubic symphysis fistulae and resultant pubic bone osteomyelitis (UPF-OM) are riddled with infections prior to extirpative surgery, our prior research noted 91.7% of patients had positive bone cultures at time of surgery. Our pathway requires holding antibiotics for 2 weeks prior to surgery and not administering IV perioperative antibiotics until the bone is removed at the time of extirpative treatment. This study aims to evaluate the rates of post-operative surgical infections and complications after extirpative surgery for UPF-OM. Methods: Using the NSQIP database, 36 patients undergoing extirpative surgery for UPF-OM were collected between 2016-2021. Pre- and post-operative characteristics and outcomes were evaluated. At our institution patients with UPF-OM undergo a standard workup and treatment pathway including MRI of pelvis confirming osteomyelitis, pre-operative nutritional labs, and optimization of modifiable risk factors. We involve a multi-disciplinary team including urology, orthopedics, infectious disease, plastic surgery, colorectal surgery if concurrent rectourethral fistula, and acute pain service. Results: The median age at time of surgery was 74.32 years (68.46,78.28). Baseline patient characteristics included history of radiation in all patients, 4 (11.11%) had a history of tobacco use within 1 year, diabetes 10 (27.78%), median albumin 3.4 (3.2,3.6), and a median BMI of 27.1 (24.2,30.88). The median operating room time was 371 minutes (344.5,408) and the median length of hospitalization was 8 days (7,10). 6 (16.7%) patients had readmissions related to surgery including 1 small bowel obstruction managed conservatively, 2 readmissions for infection, 2 for dehydration, and 1 for anemia/presyncope. No patients had a bowel anastomotic leak, ureteroenteric leak, or rectal injury. During admission no patients had surgical site infections, deep surgical site infections, urinary tract infections, or sepsis/SIRS at 48 hours. Conclusions: The rates of severe post-operative complications in extirpative surgery for UPF-OM are low. These findings are surprising given the complexity of the disease process and underlying infected/contaminated field inherent to UPF-OM. Given our pathway that withholds antibiotics until late in the extirpative procedure the rates of infection are exceedingly low and were only present at delayed readmissions. SOURCE OF Funding: Boston Scientific Fellowship Grant
