Allan Okrainec1,2, Mary-Anne Aarts2,3, Lesley Gotlib Conn4, Stuart McCluskey5,6, Marg McKenzie7,8, Emily A Pearsall7,8, Ori Rotstein2,9, J Charles Victor10, Robin S McLeod11,12,13,14. 1. Department of Surgery, University Health Network, Toronto, ON, Canada. 2. Department of Surgery, University of Toronto, Toronto, ON, Canada. 3. Department of Surgery, Toronto East General Hospital, Toronto, ON, Canada. 4. Sunnybrook Health Sciences Center, Sunnybrook Research Institute, Toronto, ON, Canada. 5. Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada. 6. Department of Anesthesia, University of Toronto, Toronto, ON, Canada. 7. Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada. 8. Zane Cohen Clinical Research Unit, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, New York, NY, USA. 9. Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada. 10. Sunnybrook Health Sciences Centre, Institute for Evaluative Clinical Sciences, Toronto, ON, Canada. 11. Department of Surgery, University of Toronto, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca. 12. Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca. 13. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. robin.mcleod@cancercare.on.ca. 14. Cancer Care Ontario, 16th floor, 620 University Ave, Toronto, ON, M5G 1L7, Canada. robin.mcleod@cancercare.on.ca.
Abstract
OBJECTIVE: The objective of the study was to determine whether compliance with Enhanced Recovery after Surgery (ERAS) urinary catheter recommendations is associated with decreased urinary tract infections (UTI) and length of stay (LOS). METHODS: Patients having colorectal surgery at 15 academic hospitals were included. Patient and outcome data were collected prospectively. The guideline recommends that urinary catheters following colonic and rectal procedures should be removed at or before 24 and 72 h, respectively. RESULTS: Two thousand nine hundred and twenty-seven patients (1397 females and 1522 males; mean age 60.3 years) were enrolled. Small bowel or colonic procedures were performed in 1897 (64.9%) and rectal procedures in 1030 (35.2%) patients. Overall, 53.2% of patients had their catheter removed in compliance with the guidelines (44.3% after colonic resections and 69.5% after rectal resections). Following colonic operations, 0.8% of patients who were guideline compliant had a UTI compared to 4.1% non-compliant patients (RR 0.20, 95% CI 0.07-0.58; p = 0.003). Following rectal operations, 3.5% of patients who were guideline compliant had a UTI compared to 9.6% of patients who were non-compliant (RR 0.37, 95% CI 0.20-0.68; p = 0.001). Median LOS was decreased in compliant patients: 4 vs 5 days following colonic procedures (RR 0.73, 95% CI 0.66-0.82; p < 0.0001) and 5 vs 8 days following rectal procedures (RR 0.54, 95% CI 0.49-0.59; p < 0.001). CONCLUSION: Early removal of urinary catheters is associated with a decreased risk of UTI and LOS.
OBJECTIVE: The objective of the study was to determine whether compliance with Enhanced Recovery after Surgery (ERAS) urinary catheter recommendations is associated with decreased urinary tract infections (UTI) and length of stay (LOS). METHODS:Patients having colorectal surgery at 15 academic hospitals were included. Patient and outcome data were collected prospectively. The guideline recommends that urinary catheters following colonic and rectal procedures should be removed at or before 24 and 72 h, respectively. RESULTS: Two thousand nine hundred and twenty-seven patients (1397 females and 1522 males; mean age 60.3 years) were enrolled. Small bowel or colonic procedures were performed in 1897 (64.9%) and rectal procedures in 1030 (35.2%) patients. Overall, 53.2% of patients had their catheter removed in compliance with the guidelines (44.3% after colonic resections and 69.5% after rectal resections). Following colonic operations, 0.8% of patients who were guideline compliant had a UTI compared to 4.1% non-compliant patients (RR 0.20, 95% CI 0.07-0.58; p = 0.003). Following rectal operations, 3.5% of patients who were guideline compliant had a UTI compared to 9.6% of patients who were non-compliant (RR 0.37, 95% CI 0.20-0.68; p = 0.001). Median LOS was decreased in compliant patients: 4 vs 5 days following colonic procedures (RR 0.73, 95% CI 0.66-0.82; p < 0.0001) and 5 vs 8 days following rectal procedures (RR 0.54, 95% CI 0.49-0.59; p < 0.001). CONCLUSION: Early removal of urinary catheters is associated with a decreased risk of UTI and LOS.
Entities:
Keywords:
Enhanced Recovery after Surgery; Guidelines; Urinary tract infections
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