Indwelling catheters increase altered mental status and urinary tract infection risk: A retrospective Cohort Study

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...

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Bibliographic Details
Published in:	Annals of medicine and surgery Vol. 64; p. 102186
Main Authors:	Fukushima, Toko, Shoji, Kazuhiro, Tanaka, Atsuko, Aoyagi, Yukari, Okui, Shoko, Sekiguchi, Marie, Shiba, Ayako, Hiroe, Takanori, Mio, Yasushi
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-04-2021 Elsevier
Subjects:	Cohort Study Delirium Perioperative complication Urinary catheter Urinary tract infection Delirium CAM-ICU CDC OR SCr Perioperative complication CI Urinary catheter IPW Urinary tract infection ASD ICU ASA-PS IUCs AKI CDC, Center for Disease Control and Prevention IPW, inverse probability weighting CI, confidence interval ICU, intensive care unit CAM-ICU, Confusion Assessment Method for the ICU OR, odds ratio IUCs, indwelling urinary catheters ASA-PS, American Society of Anesthesiology physical status ASD, absolute standardized differences AKI, acute kidney injury SCr, serum creatinine levels
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Summary:	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. 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. 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). 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. •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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2049-0801 2049-0801
DOI:	10.1016/j.amsu.2021.102186