Heidi Wald1, Anne Epstein, Andrew Kramer. 1. Divisions of Health Care Policy and Research, University of Colorado Health Sciences Center, Aurora, Colorado 80011, USA. wald@uchsc.edu
Abstract
BACKGROUND: Indwelling urinary catheters are used postoperatively in hip fracture care. Their use beyond the immediate postoperative period may result in excess nosocomial infections. OBJECTIVES: The objectives of this study were to explore the relationship between extended indwelling urinary catheterization and outcomes for patients sustaining hip fracture discharged to skilled nursing facilities (SNFs), and to describe patient and hospital predictors of extended indwelling urinary catheterization. RESEARCH DESIGN: The authors conducted a retrospective cohort study. SUBJECTS: This study consisted of Medicare admissions to SNFs of patients discharged from a hospital with a primary diagnosis of hip fracture in 2001 (n=111,330). MEASURES: Dependent variables were the presence of urinary catheter at SNF admission and the patient-specific 30-day outcomes of rehospitalization for urinary tract infection, rehospitalization for sepsis, discharge to the community, and mortality. Independent variables were demographic, clinical, and hospital characteristics. RESULTS: Thirty-two percent of hip fracture discharges to SNFs had urinary catheters. These patients had greater odds of rehospitalization for urinary tract infection (adjusted odds ratio [AOR] 1.6, P<0.001) and death (AOR 1.3, P<0.001) at 30 days than patients without catheters after adjusting for patient characteristics such as age and comorbid conditions. Western region and urban location were associated with a higher likelihood of having an indwelling urinary catheter, whereas northern region and teaching hospital status were associated with a lower likelihood of having an indwelling urinary catheter. CONCLUSIONS: Extended use of indwelling urinary catheters postoperatively is associated with poor outcomes. The likelihood of having an indwelling urinary catheter at hospital discharge after hip fracture is associated with hospital characteristics in addition to patient characteristics. This practice variation deserves further study.
BACKGROUND: Indwelling urinary catheters are used postoperatively in hip fracture care. Their use beyond the immediate postoperative period may result in excess nosocomial infections. OBJECTIVES: The objectives of this study were to explore the relationship between extended indwelling urinary catheterization and outcomes for patients sustaining hip fracture discharged to skilled nursing facilities (SNFs), and to describe patient and hospital predictors of extended indwelling urinary catheterization. RESEARCH DESIGN: The authors conducted a retrospective cohort study. SUBJECTS: This study consisted of Medicare admissions to SNFs of patients discharged from a hospital with a primary diagnosis of hip fracture in 2001 (n=111,330). MEASURES: Dependent variables were the presence of urinary catheter at SNF admission and the patient-specific 30-day outcomes of rehospitalization for urinary tract infection, rehospitalization for sepsis, discharge to the community, and mortality. Independent variables were demographic, clinical, and hospital characteristics. RESULTS: Thirty-two percent of hip fracture discharges to SNFs had urinary catheters. These patients had greater odds of rehospitalization for urinary tract infection (adjusted odds ratio [AOR] 1.6, P<0.001) and death (AOR 1.3, P<0.001) at 30 days than patients without catheters after adjusting for patient characteristics such as age and comorbid conditions. Western region and urban location were associated with a higher likelihood of having an indwelling urinary catheter, whereas northern region and teaching hospital status were associated with a lower likelihood of having an indwelling urinary catheter. CONCLUSIONS: Extended use of indwelling urinary catheters postoperatively is associated with poor outcomes. The likelihood of having an indwelling urinary catheter at hospital discharge after hip fracture is associated with hospital characteristics in addition to patient characteristics. This practice variation deserves further study.
Authors: Pranita D Tamma; Alison E Turnbull; Aaron M Milstone; Christoph U Lehmann; Emily R M Sydnor; Sara E Cosgrove Journal: Clin Infect Dis Date: 2011-05-02 Impact factor: 9.079