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Risk Factors for Re-insertion of Urinary Catheter Following Early Removal in Thoracic Surgical Patients
*John Young, *Travis Geraci, David Harrington, William Cioffi, Thomas Ng
Department of Surgery, Alpert Medical School of Brown University, Providence, RI
Objective: To reduce the incidence of urinary tract infection (UTI), Surgical Care Improvement Project (SCIP)-9 mandates the removal of urinary catheter within 48 hours postoperatively. Patients with epidural analgesia are not exempted from SCIP-9. We sought to determine the urinary catheter re-insertion rate after early removal in patients undergoing thoracic surgery with thoracic epidural analgesia, and to determine the factors that are associated with re-insertion.
Design: Prospective cohort observational study
Setting: Tertiary-care/Academic Hospital
Patients: Consecutive patients undergoing major pulmonary or esophageal resection with thoracic epidural analgesia over a two year period. Excluded are patients with chronic indwelling catheter, patients with urostomy, and patients needing strict urine output monitoring in the critical care setting.
Interventions: SCIP-9, early removal of urinary catheter, within 48 hours postoperatively
Main Outcome Measures: Urinary catheter re-insertion rate, complications of catheter re-insertion, UTI rate, rate of discharge with urinary catheter
Results: There were 288 patients evaluated, 13 met exclusion criteria and 275 were included with 60/275(21.8%) requiring re-insertion of urinary catheter. Median catheter days was significantly longer in the re-insertion group (median 5 vs 2 days, p<0.001). There was no difference in the UTI rate between patients without re-insertion, 1/215(0.5%) vs those requiring re-insertion, 1/60(1.7%); p=0.389. Urethral trauma during re-insertion was seen in 1/60(1.7%). After re-insertion, discharge with urinary catheter was required in 4/60(6.7%). Multiple logistic regression analysis found male gender, lower Body-Mass Index, presence of benign prostatic hypertrophy and esophagectomy to be independent risk factors associated with catheter re-insertion.
Conclusions: When applying SCIP-9 to patients undergoing thoracic procedures with thoracic epidural analgesia, consideration to delayed removal of urinary catheter may be warranted in patients with multiple risk factors for re-insertion.
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