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Urinary catheter use in patients with hip fracture: Are current guidelines appropriate? A retrospective review
Sruthi Thomas1, Nicole Harris1, Johanna Dobransky1
1From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont.
Insights
Urinary catheter use in hip fracture patients is high, with indwelling catheters linked to increased urinary tract infections and postoperative urinary retention. Adherence to guidelines for catheter use is needed to reduce complications.
Area of Science:
- Urology
- Geriatric Medicine
- Infectious Disease
Background:
- Clinical guidelines recommend limiting urinary catheter use in hip fracture patients to prevent complications like urinary tract infection (UTI) and postoperative urinary retention (POUR).
- Current practices regarding urinary catheterization in hip fracture patients often deviate from established guidelines.
- This study aimed to assess adherence to guidelines, incidence of POUR and UTI, and associated risk factors.
Purpose of the Study:
- To compare current urinary catheterization practices in hip fracture patients with clinical guidelines.
- To determine the incidence of postoperative urinary retention (POUR) and urinary tract infection (UTI) in this patient population.
- To identify risk factors contributing to the development of POUR and UTI following hip fracture surgery.
Main Methods:
- Retrospective chart review of 583 hip fracture patients treated at a tertiary care center from November 2015 to October 2017.
- Data collection included comorbidities, catheterization details (type, duration), and outcomes (POUR, UTI, length of stay).
- Statistical analysis was performed to compare practices to guidelines and identify risk factors for complications.
Main Results:
- A high rate of catheter use (77.2%) was observed, with indwelling catheters predominantly used (92.4%).
- Postoperative urinary retention (POUR) occurred in 16.8% of patients, with longer indwelling catheter duration (>24 hours) increasing POUR risk (OR 2.2).
- Urinary tract infection (UTI) developed in 10.6% of patients; catheter use significantly increased UTI risk (OR 6.6), and longer catheter use correlated with higher UTI incidence.
Conclusions:
- Frequent use of indwelling urinary catheters in hip fracture patients indicates poor adherence to clinical guidelines.
- Prolonged duration of catheterization is associated with increased rates of both UTI and POUR.
- Further research is necessary to understand the reasons behind the prevalent use of indwelling catheters over intermittent catheterization.
Background:
Guidelines for urinary catheterization in patients with hip fracture recommend limiting catheter use and using intermittent catheterization preferentially to avoid complications such as urinary tract infection (UTI) and postoperative urinary retention (POUR). We aimed to compare current practices to clinical guidelines, describe the incidence of POUR and UTI, and determine factors that increase the risk of these complications.
Methods:
We retrospectively reviewed the charts of patients with hip fracture who presented to a single large tertiary care centre in southeastern Ontario between November 2015 and October 2017. Data collected included comorbidities, catheter use and length of stay. We compared catheter use to guidelines, and investigated the incidence of and risk factors for POUR and UTI.
Results:
We reviewed the charts of 583 patients, of whom 450 (77.2%) were treated with a catheter, primarily indwelling (416 [92.4%]). Postoperative urinary retention developed in 98 patients (16.8%); however, it did not affect length of stay (p = 0.2). Patients with indwelling catheters for more than 24 hours after surgery had a higher incidence of POUR than those who had their catheter removed before 24 hours (65/330 [19.7%] v. 10/98 [10.2%]) (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.06-4.38). A UTI developed postoperatively in 62 patients (10.6%). Catheter use was associated with a 6.6-fold increased risk of UTI (OR 6.6, 95% CI 2.03-21.4). Patients with indwelling catheters did not have a significantly higher incidence of UTI than those with intermittent catheterization (57/416 [13.7%] v. 2/34 [5.9%]) (p = 0.2). Patients who developed a UTI had significantly longer catheter use than patients who did not (p < 0.002).
Conclusion:
Indwelling catheters were used frequently, which suggests low compliance with clinical guidelines. Longer duration of catheter use led to higher rates of UTI and POUR. Further investigation of the reasons for the common use of indwelling rather than intermittent catheterization is needed.
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