Indwelling Urinary Catheter for Total Joint Arthroplasty Using Epidural Anesthesia

Area of Science:

• Anesthesiology
• Urology
• Orthopedic Surgery

Background:

• Genitourinary (GU) complications are a concern after total joint arthroplasty (TJA).
• The necessity of preoperative indwelling urinary catheters in TJA patients under epidural anesthesia is debated.
• This study investigates the impact of omitting preoperative urinary catheters on postoperative GU issues.

Purpose of the Study:

• To evaluate if not using an indwelling urinary catheter increases adverse genitourinary (GU) issues after TJA.
• To compare GU complication rates between patients who received and did not receive a preoperative urinary catheter.
• To inform clinical practice regarding routine catheter use in TJA under epidural anesthesia.

Main Methods:

• Retrospective review of 335 consecutive patients undergoing primary TJA with epidural anesthesia.
• Comparison of 103 patients with preoperative urinary catheters versus 232 patients without.
• Analysis of demographics, medical and GU complications, and length of stay.

Main Results:

• No significant differences in demographics or overall GU complications between catheter and non-catheter groups.
• A higher urinary tract infection rate was observed in the catheter group among patients with a history of prostate disorders (P = .023).
• Postoperative GU complications were associated with increased patient age and longer hospital stays.

Conclusions:

• Omitting preoperative indwelling urinary catheters in TJA patients under epidural anesthesia does not elevate the risk of postoperative urological complications.
• The routine use of preoperative urinary catheters for this patient population may be reconsidered.
• Findings support a more selective approach to catheterization in TJA patients receiving epidural anesthesia.