Samuel T Roberts1,2, Kiraati Patel1, Stephen R Smith1,2. 1. Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia. 2. Faculty of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
Abstract
BACKGROUND: The presence of an indwelling urinary catheter (IDUC) is routine following colorectal resections. In Enhanced Recovery After Surgery programmes, excessive intravenous fluids (IVFs) are avoided. This study sought to determine whether the routine absence of an IDUC following colorectal surgery improved post-operative outcomes and minimized fluid prescription. METHODS: A retrospective comparative cohort study was performed on patients undergoing colorectal resection at a tertiary referral teaching hospital, over a 7-year period. A policy of no routine IDUC was introduced over the last 3 years. Patients were divided into cohorts based on the presence or absence of an IDUC on leaving the operating theatre. The outcomes assessed were IVF prescription, length of stay, mortality and morbidity. RESULTS: Of the 213 resections over the time period, 131 met the inclusion criteria (87 IDUC and 44 no IDUC). There was no difference between groups with respect to baseline demographics. Fluid administration was less in the group without routine IDUC (total fluid 6.16 L versus 10.89 L; P < 0.0001, fluid in the first 24 h 3.82 L versus 5.3 L; P < 0.0001 and fluid in the first 48 h 5.15 L versus 7.23 L; P < 0.0001). Length of stay was less in the 'no IDUC' group (5.9 days versus 10.1 days; P = 0.0009). There was no difference in morbidity and mortality. CONCLUSION: A policy of no IDUC following colectomy was associated with a reduction in IVF administration and length of stay. A randomized controlled trial is recommended in order to more accurately determine the degree of causal relationship.
BACKGROUND: The presence of an indwelling urinary catheter (IDUC) is routine following colorectal resections. In Enhanced Recovery After Surgery programmes, excessive intravenous fluids (IVFs) are avoided. This study sought to determine whether the routine absence of an IDUC following colorectal surgery improved post-operative outcomes and minimized fluid prescription. METHODS: A retrospective comparative cohort study was performed on patients undergoing colorectal resection at a tertiary referral teaching hospital, over a 7-year period. A policy of no routine IDUC was introduced over the last 3 years. Patients were divided into cohorts based on the presence or absence of an IDUC on leaving the operating theatre. The outcomes assessed were IVF prescription, length of stay, mortality and morbidity. RESULTS: Of the 213 resections over the time period, 131 met the inclusion criteria (87 IDUC and 44 no IDUC). There was no difference between groups with respect to baseline demographics. Fluid administration was less in the group without routine IDUC (total fluid 6.16 L versus 10.89 L; P < 0.0001, fluid in the first 24 h 3.82 L versus 5.3 L; P < 0.0001 and fluid in the first 48 h 5.15 L versus 7.23 L; P < 0.0001). Length of stay was less in the 'no IDUC' group (5.9 days versus 10.1 days; P = 0.0009). There was no difference in morbidity and mortality. CONCLUSION: A policy of no IDUC following colectomy was associated with a reduction in IVF administration and length of stay. A randomized controlled trial is recommended in order to more accurately determine the degree of causal relationship.