Optimal Timing of Urinary Catheter Removal After Thoracic Operations: A Randomized Controlled Study.
BACKGROUND
There are very few randomized trials confirming the belief that prolonged urinary catheterization increases urinary tract infections, and none of these have included a comparative analysis of patients with an epidural catheter in place. The aim of this prospective randomized trial was to determine if removal of the urinary catheter within 48 hours after a thoracic operation, as required by the Surgical Care Improvement Project (SCIP) Measure 9, leads to increases in urinary tract reintervention and lower rates of urinary tract infections.


METHODS
From February 2012 to August 2014, patients undergoing a general thoracic surgical procedure in whom an epidural catheter was placed for analgesia were eligible for inclusion in the trial. Patients were randomized to urinary catheter removal within 48 hours of the operation completion or 6 hours after epidural catheter removal.


RESULTS
The study enrolled 374 patients, 217 men (58%) and 157 women (42%). The 247 eligible and evaluated patients, 141 (57.1%) men and 106 (42.9%) women, were a median age of 61.5 years (range, 21 to 87 years). There were no statistically significant differences in any of the preoperative or operative categories between the two groups. Median length of stay was 5 days (range, 2 to 42 days) for all patients, and there was no difference between the two groups. Postoperatively, 19 patients (7.7%) required urinary catheter reinsertion after it was removed. A significantly greater number of patients in the early removal group required reinsertion of the urinary catheter (15 [12.4%] vs 4 [3.2%]); p = 0.0065). Patients whose urinary catheter was removed within 48 hours of the operation had a much higher rate of bladder scans postoperatively (59.5% [n = 72]) and required more in-and-out catheterization than those whose urinary catheter was removed 6 hours after the epidural analgesia was discontinued (31.0% [n = 39]; p < 0.0001). The only documented urinary tract infection in the entire cohort occurred in a patient whose urinary catheter was removed within 48 hours after the operation. No urinary tract infections developed in the 126 patients whose urinary catheter remained in place until the epidural catheter was removed.


CONCLUSIONS
In a randomized control trial, patients with an epidural catheter in place after a general thoracic surgical operation have a higher rate of urinary problems when the urinary catheter is removed early, while the epidural catheter is still in place, compared with patients whose urinary catheter is removed after the epidural analgesia is discontinued.
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: allen.mark@mayo.edu.
Mark S
MS
Allen
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Shanda H
SH
Blackmon
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Francis C
FC
Nichols
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Stephen D
SD
Cassivi
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
William S
WS
Harmsen
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Bettie
B
Lechtenberg
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Karlyn
K
Pierson
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Dennis A
DA
Wigle
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
K Robert
KR
Shen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D062885:Urinary Catheters