(Poster 107) Predictive Nomogram for Reducing UTI-Related Cancellations in Urodynamic Testing

Objectives: This study aimed to develop and evaluate a nomogram to predict the risk of same-day cancellations of office urodynamic procedures due to urinary tract infections (UTIs).

Methods: This was an IRB-approved, retrospective cohort study evaluating patients who underwent office urodynamics at a single institution from August 1, 2022, through April 30, 2024, via electronic medical record review. Patient demographics, medical history, PFDI-20, office evaluation, and urodynamic cancellations were collected. Patients who experienced same-day cancellation and rescheduling of urodynamics secondary to UTI were compared to those who underwent testing as scheduled to identify risk factors for cancellation. A logistic regression model incorporating the Least Absolute Shrinkage and Selection Operator (LASSO) method was utilized to select the most predictive and reliable variables. Subsequently, these variables were incorporated into a nomogram designed to guide clinicians in the pre-procedure identification and management of patients at elevated risk for same-day cancellations.

Results: A total of 587 patients were included in the analysis, among whom 41 (7.0%) experienced same-day cancellations of urodynamic procedures due to UTI, and 546 completed the procedures as scheduled. The mean participant age was 65, and most identified as White (78.9%). Patients experiencing cancellations were significantly older (mean age 77.0 years vs. 64.5 years; p< 0.001) and more likely to have diabetes (26.8% vs. 14.8%; p=0.042) compared to those who did not experience cancellations. The LASSO regression identified age and BMI as the most predictive variables (Figure 1). The final logistic regression model demonstrated good discriminative ability (C-index = 0.77; 95% CI 0.68–0.84), modest explanatory power (R-squared = 0.147), and appropriate calibration (Brier score = 0.06), particularly given the low incidence of cancellations. At an optimal threshold, the model achieved a sensitivity of 83.0%, a specificity of 67.0%, and an overall accuracy of 89.1% for predicting same-day cancellations due to UTI (Figure 2).

Conclusions: Among patients presenting for urodynamic studies, those most at risk for cancellation due to UTI included those of increasing age and BMI. Although diabetes was not selected as a variable for this model, it was also found to be a significant risk factor, and this history may be taken into account by clinicians when making decisions to treat patients for UTI prophylactically. Urogynecologists may consider implementing this nomogram to identify these at-risk patients and appropriately treat them before their procedure based on their clinical tolerance of UTI risk to reduce office administrative burden and costs related to canceled procedures and testing. Reduction of rescheduled visits likely leads to an increase in patient satisfaction and an overall improvement in timely access to care.