title: Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial.
abstract: OBJECTIVE
  To prevent urinary retention, urinary catheters commonly are removed only after thoracic epidural discontinuation after thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection after early catheter removal.
  
  
  METHODS
  This study described a prospective trial instituting an early urinary catheter removal protocol compared with a historic control group of patients.
  
  
  METHODS
  The protocol was instituted at a single, academic thoracic surgery unit.
  
  
  METHODS
  The study group was comprised of patients undergoing surgery requiring thoracotomy who received an intraoperative epidural for postoperative pain control.
  
  
  METHODS
  An early urinary catheter removal protocol was instituted prospectively, with all catheters removed on or before postoperative day 2. Urinary retention was determined by bladder ultrasound and treated with recatheterization.
  
  
  RESULTS
  The primary outcomes were urinary retention rate, defined as bladder volume>400 mL, and urinary tract infection rate. Results were compared with a retrospective cohort of 210 consecutive patients who underwent surgery before protocol initiation. Among the 101 prospectively enrolled patients, urinary retention rate was higher (26.7% v 12.4%, p = 0.003), while urinary tract infection rate improved moderately (1% v 3.8%, p = 0.280).
  
  
  CONCLUSIONS
  Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multifaceted approach to reducing the incidence of catheter-associated urinary tract infections.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Craig
authors.affiliation: Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: John C
authors.initials: JC
authors.lastname: Rowlingson
authors.affiliation: Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Steve P
authors.initials: SP
authors.lastname: Morton
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Thomas
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Persinger
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA; Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: James
authors.initials: J
authors.lastname: Isbell
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA. Electronic address: bdk8g@virginia.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods* / Q000639:trends; D015331:Cohort Studies; D020878:Device Removal / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects / Q000639:trends; D013997:Time Factors; D062885:Urinary Catheters / Q000382:microbiology / Q000639:trends
keywords: epidural anesthesia; thoracic epidural anesthesia; thoracic surgical procedures; urinary catheter removal; urinary catheterization; urinary retention; urinary tract infections