title: Extended use of urinary catheters in older surgical patients: a patient safety problem?
abstract: OBJECTIVE
  To explore the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  US acute care hospitals and skilled nursing facilities.
  
  
  METHODS
  A total of 170,791 Medicare patients aged 65 years or more who were admitted to skilled nursing facilities after discharge from a hospital with a primary diagnosis code indicating major cardiac, vascular, orthopedic, or gastrointestinal surgery in 2001.
  
  
  METHODS
  Patient-specific 30-day rate of rehospitalization for urinary tract infection (UTI) and 30-day mortality rate, as well as the risk of having an indwelling urinary catheter at the time of admission to a skilled nursing facility.
  
  
  RESULTS
  A total of 39,282 (23.0%) of the postoperative patients discharged to skilled nursing facilities had indwelling urinary catheters. After adjusting for patient characteristics, the patients with catheters had greater odds of rehospitalization for UTI and death within 30 days than patients who did not have catheters. The adjusted odds ratios (aORs) for UTI ranged from 1.34 for patients who underwent gastrointestinal surgery (P<.001) to 1.85 for patients who underwent cardiac surgery (P<.001); the aORs for death ranged from 1.25 for cardiac surgery (P=.01) to 1.48 for orthopedic surgery (P=.002) and for gastrointestinal surgery (P<.001). After controlling for patient characteristics, hospitalization in the northeastern or southern regions of the United States was associated with a lower likelihood of having an indwelling urinary catheter, compared with hospitalization in the western region (P=.002 vs P=.03).
  
  
  CONCLUSIONS
  Extended postoperative use of indwelling urinary catheters is associated with poor outcomes for older patients. The likelihood of having an indwelling urinary catheter at the time of discharge after major surgery is strongly associated with a hospital's geographic region, which reflects a variation in practice that deserves further study.
authors.affiliation: Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, USA. heidi.wald@uchsc.edu
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.forename: Anne M
authors.initials: AM
authors.lastname: Epstein
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Radcliff
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kramer
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology / Q000706:statistics & numerical data; D015331:Cohort Studies; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D012449:Safety; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000401:mortality*