SHM Converge Scientific Abstract ePoster Gallery-Reducing Unnecessary Preoperative Urinalysis Screening in Orthopedic Surgeries

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This retrospective chart review examined the overuse of screening preoperative urinalyses (UAs) before orthopedic surgery, specifically hip and femoral fracture repairs at UC San Diego in 2020. The study was motivated by evidence that asymptomatic bacteriuria (ASB) is common but does not benefit from treatment in patients undergoing non-urologic surgery, and by IDSA guidelines recommending against screening or treating ASB in this setting.<br /><br />Among 206 admissions, 177 (86%) had a documented recommendation for a preoperative UA. After excluding patients whose urine testing was done for other reasons such as renal injury, altered mental status, or sepsis/UTI, 122 patients (69%) actually had a UA obtained, and 96 of these were ordered purely for screening. Of those screened, 28 (29%) had abnormal findings such as pyuria, leukocyte esterase, or nitrites. Antibiotics were prescribed to 13 of these 28 patients (46%), including 4 patients who received only a single preoperative dose despite lack of evidence supporting this practice for ASB.<br /><br />The study found a high rate of low-value preoperative urine screening and frequent antibiotic treatment based on urine abnormalities alone. No adverse events were reported from withholding antibiotics in patients with ASB, and no complications were noted among those who did receive antibiotics, though the sample size was small.<br /><br />Overall, the authors concluded that there are clear opportunities for education, improved ordering practices, and better antibiotic stewardship to reduce unnecessary testing and treatment before orthopedic surgery.

Asset Subtitle

Helen J. Chou

Meta Tag

Author List Ali Farkhondehpour, Helen J. Chou

Category Research

Concept Asymptomatic Bacteriuria

Concept Urinalysis

Concept Orthopedic Surgery

Concept Non-Urologic Surgery

Concept Antimicrobial Stewardship Program

Distinguished Non-Finalist

Presenter Organization UC San Diego Health

Presenting Author Helen J. Chou

Track Value in Hospital Medicine

Keywords

preoperative urinalysis

orthopedic surgery

asymptomatic bacteriuria

screening overuse

antibiotic stewardship

hip fracture repair

femoral fracture repair

urine abnormalities

low-value care

IDSA guidelines

Asymptomatic Bacteriuria

Urinalysis

Orthopedic Surgery

Non-Urologic Surgery

Antimicrobial Stewardship Program