Indwelling urinary catheter use in the postoperative period - Analysis of the National Surgical Infection Prevention Project data

Objectives: To describe the frequency and duration of perioperative catheter use and to determine the relationship between catheter use and postoperative outcomes. Design: Retrospective cohort study. Setting: Two thousand nine hundred sixty-five acute care US hospitals. Patients: Medicare inpatients (N=35 904) undergoing major surgery (coronary artery bypass and other open-chest cardiac operations; vascular surgery; general abdominal colorectal surgery; or hip or knee total joint arthroplasty) in 2001. Main Outcome Measure: Postoperative urinary tract infection. Results: Eighty-six percent of patients undergoing major operations had perioperative indwelling urinary catheters. Of these, 50% had catheters for longer than 2 days postoperatively. These patients were twice as likely to develop urinary tract infections than patients with catheterization of 2 days or less. In multivariate analyses, a postoperative catheterization longer than 2 days was associated with an increased likelihood of in-hospital urinary tract infection (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41) and 30-day mortality ( parameter estimate, 0.54; 95% CI, 0.37-0.72) as well as a decreased likelihood of discharge to home (parameter estimate, -0.57; 95% CI, -0.64 to -1.51). Conclusions: Indwelling urinary catheters are routinely in place longer than 2 days postoperatively and may result in excess nosocomial infections. The association with adverse outcomes makes postoperative catheter duration a reasonable target of infection control and surgical quality-improvement initiatives.