Indwelling catheters increase altered mental status and urinary tract infection risk: A retrospective Cohort Study. (April 2021)

• Record Type: Journal Article
• Authors: Fukushima, Toko; Shoji, Kazuhiro; Tanaka, Atsuko; Aoyagi, Yukari; Okui, Shoko; Sekiguchi, Marie; Shiba, Ayako; Hiroe, Takanori; Mio, Yasushi
• Is Part Of: Annals of medicine and surgery. Volume 64(2021)
• Publication Date: 2021-04
• Subjects: Urinary catheter -- Perioperative complication -- Delirium -- Urinary tract infection; AKI acute kidney injury -- ASA-PS American Society of Anesthesiology physical status -- ASD absolute standardized differences -- CAM-ICU Confusion Assessment Method for the ICU -- CDC Center for Disease Control and Prevention -- CI confidence interval -- ICU intensive care unit -- IPW inverse probability weighting -- IUCs indwelling urinary catheters -- OR odds ratio -- SCr serum creatinine levels; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.102186
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Although indwelling urinary catheters (IUCs) are used intraoperatively and may cause complications ( e.g., delirium), only few robust studies have investigated the association between intraoperative IUC use and complications. We hypothesized that IUC use might increase the postoperative incidence of altered mental status and/or urinary catheter infection. Materials and methods: In this retrospective single-center cohort study, we analyzed the data of adult patients undergoing surgery at our facility between January 2013 and December 2018. The primary endpoint was altered mental status and/or incidence of urinary catheter infections. The patients were divided into IUC and control groups. A multivariable logistic regression model was used to identify the predictors of postoperative complications, and a multivariable Cox proportional hazards regression model was used to analyze hospital discharge in unmatched and inverse propensity-weighted patients. Results: Of the 14, 284 patients that were reviewed, we analyzed 5112 patients (control group, 44.0%; IUC group, 56.0%). Almost all procedures comprised less invasive surgeries. The prevalence of postoperative altered mental status and postoperative urinary catheter infection were 3.56% and 0.04%, respectively. After inverse propensity weighting, all baseline characteristics were similar between the two groups. However, patients with IUCs had a higher risk of postoperative complications (adjusted odds ratio, 1.97; 95% confidence interval [CI], 1.50–2.59) and prolonged hospital stays (hazard ratio, 0.84; 95% CI, 0.80–0.89). Conclusion: In patients undergoing less invasive surgery, IUCs may be associated with a relatively high risk of altered mental status or urinary catheter infection. These data may facilitate preoperative discussions regarding the perioperative use of IUCs. Highlights: IUCs may increase the incidence of altered mental status postoperatively. IUCs may increase the incidence of urinary catheter infections postoperatively. IUC use might be a risk factor for prolonged hospital stay. Our results may facilitate preoperative discussions regarding perioperative IUC use.