Risk Factors for Infection after Prostate Biopsy in the United States

• Published in: Urology (Ridgewood, N.J.) N.J.), 2020-04, Vol.138, p.113-118
• Main Authors: Shoag, Jonathan E., Gaffney, Christopher, Pantuck, Morgan, Sun, Tianyi, Gorin, Michael, Schaeffer, Edward, Sedrakyan, Art, Vickers, Andrew, Hu, Jim
• Format: Article
• Language: English
• Subjects: Aged; Biopsy - adverse effects; Biopsy - statistics & numerical data; Cohort Studies; Humans; Male; Medicare - statistics & numerical data; Odds Ratio; Patient Admission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - microbiology; Prostate - pathology; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Risk Factors; SEER Program - statistics & numerical data; Surgeons - statistics & numerical data; United States - epidemiology; Workload - statistics & numerical data
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2019.12.023

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2001 to 2015 and recorded 30-day infection rates and emergency department, hospital and, intensive care unit (ICU) admissions. We performed adjusted analyses to analyze the effect of age, demographic data, surgeon volume, rectal swab use, and biopsy year on infections. We found that the overall rate of postbiopsy infections increased from 2001 (5.9%) to 2007 (7.2%) but remained stable through 2015. Despite this, postbiopsy emergency room visits rose from 0.2% to 0.5% (95% confidence interval [CI] 0.2%-0.4%, P < .01), hospitalizations rose from 0.5% to 1.3% (95% CI 0.5%-1.0%, P < .01), and ICU admissions increased from 0.1% to 0.3% (95% CI 0.1%-0.3%, P < .01). Patients of surgeons who performed 25 biopsies per year had lower odds of postbiopsy infection (odds ratio 0.65; 95% CI 0.61-0.69) and a lower risk of hospitalization (odds ratio 0.50; 95% CI 0.43-0.59) as compared to patients of surgeons who performed one biopsy per year. Rectal swab use increased over the study period but remained low (1.8% in 2015). While the overall rate of postbiopsy infections has stabilized since 2007, admissions to the emergency room, hospital, and ICU continue to rise. Increased surgeon volume was associated with a decreased risk of infection.