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Analysis of the National Surgical Infection Prevention Project Data

Heidi L. Wald, MD, MSPH; Allen Ma, PhD; Dale W. Bratzler, DO, MPH; Andrew M. Kramer, MD

Arch Surg. 2008;143(6):551-557.

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.

Author Affiliations: Division of Health Care Policy and Research, University of Colorado Denver School of Medicine, Denver (Drs Wald and Kramer); and Oklahoma Foundation for Medical Quality, Inc, Oklahoma City (Drs Ma and Bratzler).