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

Toko Fukushima; Kazuhiro Shoji; Atsuko Tanaka; Yukari Aoyagi; Shoko Okui; Marie Sekiguchi; Ayako Shiba; Takanori Hiroe; Yasushi Mio

doi:10.1016/j.amsu.2021.102186

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

Ann Med Surg (Lond). 2021 Mar 6:64:102186. doi: 10.1016/j.amsu.2021.102186. eCollection 2021 Apr.

Authors

Toko Fukushima^{1

2}, Kazuhiro Shoji^{1

2}, Atsuko Tanaka^{1

2}, Yukari Aoyagi^{1

2}, Shoko Okui^{1

2}, Marie Sekiguchi^{1

2}, Ayako Shiba^{1

2}, Takanori Hiroe³, Yasushi Mio¹

Affiliations

¹ Tokyo Jikei University Katsushika Medical Center, Department of Anesthesiology, Tokyo, Japan.
² The Jikei University School of Medicine, Department of Anesthesiology, Tokyo, Japan.
³ Kyoto University Graduate School of Medicine, Department of Biostatistics, Kyoto, Japan.

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.

Keywords: 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; Delirium; ICU, intensive care unit; IPW, inverse probability weighting; IUCs, indwelling urinary catheters; OR, odds ratio; Perioperative complication; SCr, serum creatinine levels; Urinary catheter; Urinary tract infection.