Urinary Catheter Utility in Laparoscopic Appendectomy: Risk Benefit Analysis of Post-Operative Urinary Tract
Charoo Piplani1,2, Jennifer E Geller1,2, Sorasicha Nithikasem1,2
1Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Insights
Catheter-associated urinary tract infections (CAUTIs) are common. This study suggests omitting urinary catheterization (UC) during laparoscopic appendectomy (LA) as it increases complications without preventing bladder injury.
Area of Science:
- Urology
- Infectious Diseases
- Surgical Outcomes
Background:
- Catheter-associated urinary tract infections (CAUTIs) are a significant cause of nosocomial infections.
- Prolonged urinary catheterization (UC) is a known risk factor for CAUTIs.
- The safety and necessity of UC during laparoscopic appendectomy (LA) remain debated due to limited data on post-operative complications.
Purpose of the Study:
- To evaluate the incidence of post-operative urinary tract infections (UTIs) and other complications in patients undergoing LA with UC versus those without UC (noUC).
- To determine if UC during LA effectively prevents iatrogenic bladder injury.
- To assess the overall safety and necessity of UC in the context of LA.
Main Methods:
- Retrospective analysis of patients aged 21 years or older who underwent LA between 2016 and 2023.
- Comparison of post-operative UTI incidence, bladder injury rates, and catheter-related complications between UC and noUC groups.
- Statistical analysis using Mann-Whitney U and Fisher exact tests.
Main Results:
- A total of 981 LAs were analyzed, with 678 in the UC group and 303 in the noUC group.
- The incidence of post-operative UTI was low (0.5%), with five cases (0.7%) in the UC group and zero in the noUC group (p=0.34).
- Catheter-related complications and urinary retention occurred exclusively in the UC group, while no bladder injuries were observed in either group.
Conclusions:
- The incidence of UTI and bladder injury following LA is low, regardless of UC use.
- Urinary catheterization during LA is associated with increased catheter-related complications and urinary retention.
- Omitting urinary catheterization during laparoscopic appendectomy is a safe and potentially beneficial practice.
Abstract:
Catheter-associated urinary tract infections (CAUTIs) account for 1 million nosocomial infections annually and 75% of all hospital-acquired UTIs. A risk factor for CAUTI is prolonged urinary catheterization (UC); therefore, transitory UC during laparoscopic appendectomy (LA), a common practice justified to avoid iatrogenic bladder injury, is believed to be safe. However, data on the incidence of post-operative UC-related complications, including CAUTI, following LA or their avoidance are limited. Patients who underwent UC for LA developed more post-operative UTIs than patients without UC (noUC), without effect on the incidence of bladder injury. Retrospective analysis of patients ≥21 years who underwent LA (2016-2023) at an academic hospital. The primary outcome was post-operative UTI in UC versus noUC patients, defined as symptoms or urinalysis findings compatible with UTI within 21 days from LA. Secondary outcomes included bladder injury, catheter-related complications, time until UTI diagnosis, and antibiotic exposure. Statistics: Mann-Whitney U and Fisher exact tests; p < 0.05. Among 981 LA, there were 678 UC and 303 noUC. A majority was male (56%) and young [38 years, inter-quartile range (IQR) 28-50]. Duration of catheterization was 102 min (IQR 85-123), whereas duration of the procedure was 58 min (IQR 44-80). There were more catheter-related complications in the UC versus noUC group (10 [1.5%] vs. 0; p = 0.04). The incidence of UTI was 0.5%, with five cases (0.7%) after UC and zero for noUC (p = 0.34). UTIs were detected at 11 post-operative days (IQR 6-17) and treated with antibiotic agents for 5 days (IQR 5-13). Four UC patients had urinary retention (two required re-catheterization and discharge with an indwelling catheter). One UC urinary "retainer" developed a post-operative UTI and required hospital re-admission. There was no urinary retention in the noUC group. There were no bladder injuries. The incidence of UTI was low following LA; bladder injuries were non-existent. UC-related complications were greater among UC patients, but there was neither urinary retention and post-operative catheterization nor bladder injury in the noUC group; we suggest the omission of UC for LA.
