5, 6 The consequences of catheter-associated UTIs are significant and include prolonged hospital stay, bacteremia, prosthetic joint infection, and death, 4, 7 thus providing a strong rationale for limiting the duration of urinary catheterization postoperatively to 48 hours unless ongoing bladder dysfunction prohibits removal. 2 - 4 Any benefit of urinary catheters for patients postoperatively is offset, however, by the substantial risk of a urinary tract infection (UTI), accrued in direct relationship with the duration of catheterization, estimated to be 5% to 10% per catheter-day beyond the first 48 hours of catheterization. 1 High rates of perioperative catheter use are intended to reduce postoperative bladder dysfunction related to anesthesia, analgesia, and immobility. In the late 1990s, patients were exposed to urinary catheters on 85% of their days in the intensive care unit. Perioperative indwelling urinary catheter use has become ubiquitous. The association with adverse outcomes makes postoperative catheter duration a reasonable target of infection control and surgical quality-improvement initiatives. 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, 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).Ĭonclusions Indwelling urinary catheters are routinely in place longer than 2 days postoperatively and may result in excess nosocomial infections. These patients were twice as likely to develop urinary tract infections than patients with catheterization of 2 days or less. Of these, 50% had catheters for longer than 2 days postoperatively. Results Eighty-six percent of patients undergoing major operations had perioperative indwelling urinary catheters. Main Outcome Measure Postoperative urinary tract infection. 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. Setting Two thousand nine hundred sixty-five acute care US hospitals. Objectives To describe the frequency and duration of perioperative catheter use and to determine the relationship between catheter use and postoperative outcomes. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. Challenges in Clinical Electrocardiography.
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