Management of Retained Epidural Catheter Fragments: A Narrative Review of Individual Patient Data

Background/Objectives: Retained epidural catheter fragments are an infrequent but clinically relevant complication of neuraxial anesthesia. Optimal management remains undefined, with limited evidence guiding treatment selection or risk stratification. This systematic review synthesized individual patient data to compare treatment strategies, examine surgical outcomes, and determine predictors of intervention. Methods: A systematic review was conducted across six databases in accordance with PRISMA guidelines (PROSPERO: CRD420025638305). Adult cases of retained epidural catheter fragments were included. Functional outcomes were standardized using modified MacNab, McCormick, and Therapy-Disability-Neurology (TDN) scores. Predictors of surgery and detectability were assessed using univariate and multivariate logistic regression models with Firth correction. Results: Forty studies comprising 51 patients were included. Conservative management was chosen in 23 cases (45%); 39.1% (n = 9) ultimately required delayed surgery due to symptom onset during follow-up. Surgical removal (n = 28, 55%) was safe and yielded excellent outcomes in 95.8% of cases. Fragment length was significantly associated with increased odds of surgery (OR = 1.05, 95% CI: 1.01-1.10, p = 0.04), while catheter material was associated with surgery in univariate analysis (OR = 2.49, 95% CI: 1.08-9.00, p = 0.03). An MRI demonstrated the highest diagnostic accuracy (AUC = 0.859, cutoff = 70 mm catheter length), outperforming CT (AUC = 0.611) and X-ray (AUC = 0.533). Across all patients, 84.3% achieved "Excellent" recovery per MacNab, with no neurological deterioration in any surgical case. Conclusions: Surgical removal of retained epidural catheter fragments is safe and effective in symptomatic patients. Conservative management is viable for asymptomatic cases under structured surveillance. Catheter material and fragment length may dictate imaging selection and treatment decisions.