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ASA score of 3 or higher is an independent risk factor for UTI in rectal cancer patientsHigh surgical risk scores predict urinary infections in rectal cancer patients

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Key Takeaway
Note that an ASA score of 3 or higher is an independent risk factor for UTI in male rectal cancer surgery patients.

This post-hoc analysis of a randomized clinical trial evaluated 208 male patients undergoing rectal cancer surgery within an ERAS program. The study compared transurethral catheterization (TUC) and suprapubic catheterization (SPC) to assess outcomes including urinary tract infection (UTI), bacteriuria, and pyuria.

Primary results showed a UTI rate of 9.1% (19 of 208 patients) within 4 days of surgery. Secondary outcomes included bacteriuria in 12.5% (26 of 208) and pyuria in 69.7% (145 of 208) of the cohort. Univariate analysis identified age greater than or equal to 65 years (OR 3.08; 1.07-8.89; p = 0.038), hypertension (OR 3.65; 1.23-10.84; p = 0.020), and ASA score greater than or equal to 3 (OR 4.15; 1.53-11.2; p = 0.005) as risk factors for UTI until postoperative day 4.

Multivariate analysis confirmed that an ASA score of 3 or higher is an independent risk factor for UTI in this population. The study did not provide data comparing the specific efficacy of TUC versus SPC on UTI rates. Due to the post-hoc nature of the analysis, the evidence for these specific risk factors should be interpreted with caution in clinical practice.

When a patient undergoes surgery for rectal cancer, their overall health status can significantly impact their recovery. A study of 208 men undergoing these surgeries looked at what factors led to urinary tract infections (UTIs) within the first four days after the procedure. The researchers found that patients with a high ASA score—a standard medical tool used to rate a patient's physical status—were much more likely to develop an infection.

This specific risk factor remained significant even when other variables were considered. While the study looked at different types of catheters, the main finding was that the patient's baseline health and risk level were the primary indicators for infection. Other factors like high blood pressure and being over age 65 also showed links to higher infection rates.

It is important to note that this data came from a post-hoc analysis, which means the researchers looked back at the data after the trial was finished. While the findings clearly show that a high ASA score is an independent risk factor for infection, the study did not compare the effectiveness of different catheter types. Doctors can use these findings to better identify which patients may need extra monitoring for infections after surgery.

What this means for you:
A high ASA score is a reliable predictor of urinary tract infections in men undergoing rectal cancer surgery.

Common questions

What is an ASA score and why does it matter?

An ASA score is a standard tool doctors use to rate a patient's overall physical health before surgery. In this study of 208 men, a score of 3 or higher was found to be an independent risk factor for developing a urinary tract infection within four days of rectal cancer surgery.

Who is most at risk for a urinary tract infection after surgery?

Patients with a high ASA score (3 or higher) were at higher risk. Other factors that showed a link to urinary tract infections in this study included being over age 65 and having high blood pressure (hypertension).

How many patients developed infections in the study?

Out of the 208 patients studied, 19 developed a urinary tract infection within four days of surgery. Other findings included 26 cases of bacteriuria and 145 cases of pyuria, which is the presence of white blood cells in the urine.

Study Details

Study typeRct
Sample sizen = 240
EvidenceLevel 2
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: Bladder drainage is systematically used in rectal cancer surgery in male patients, even in the era of enhanced recovery after surgery (ERAS). However, little data is available on risk factors for urinary tract infection (UTI). Identifying the risk factors associated with UTI within 4 days of male rectal cancer surgery in an ERAS program could support more individualized decision-making. METHODS: We used data from the GRECCAR 10 randomized clinical trial, a comparison of outcomes of transurethral catheterization (TUC) or suprapubic catheterization (SPC). 240 patients were randomized, 209 retained in the study (TUC  = 99; SPC  = 109). Univariate and multivariate logistic regression post-hoc study analyses were performed to assess association between potential predictive factors and UTI within 30 days after surgery. RESULTS: Out of 208 patients (median age 64.5 years), 19 (9.1%) had UTI, 26 (12.5%) had bacteriuria and 145 (69.7%) had pyuria. Univariate analysis identified age ≥ 65 years (OR = 3.08 [1.07-8.89];  = 0.038), hypertension (OR = 3.65 [1.23-10.84];  = 0.020) and ASA score ≥ 3 (OR = 4.15 [1.53-11.2];  = 0.005) as risk factors for UTI until POD4. Multivariate analysis identified ASA score ≥ 3 with a risk of UTI. CONCLUSION: Regarding male rectal cancer surgery, our study shows that nearly 1 in 10 patients had UTI within 4 days. An ASA score ≥ 3 is an independent risk factor linked to UTI. Identifying this risk factor for UTI is necessary to advise patients, support a tailored decision-making process, and prevent these complications.
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