Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort

Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures.

Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP^®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI.

Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2–1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0–1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2–2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1–15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4–0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4–2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI.

While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.