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Impact of Institutional Protocol on Urinary Catheter Outcome Measures in Orthopedic Children Treated With Epidural
Idan Katz1, Tomer Talmy1,2,3, Dor Barami1
1Division of Anesthesia, Intensive Care and Pain Medicine, Tel Aviv Sourasky Medical Center, The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel.
Insights
A new urinary catheter protocol for pediatric orthopedic surgery reduced catheter duration and reinsertions. This standardized approach improved outcomes for children receiving epidural analgesia, without increasing infection rates.
Area of Science:
- Pediatric Orthopedic Surgery
- Pain Management
- Urology
Background:
- Epidural analgesia is common for pediatric orthopedic surgery pain.
- Postoperative urinary retention is a risk, often leading to prolonged catheterization.
- Prolonged catheterization carries risks like infection and discomfort.
Purpose of the Study:
- To evaluate a standardized urinary catheter management protocol.
- Assessed outcomes in children under 18 undergoing major lower-limb orthopedic surgery.
- Focused on children receiving postoperative epidural analgesia.
Main Methods:
- Retrospective observational study at a single center.
- Compared outcomes before and after protocol implementation (Jan 2019 - Jul 2023).
- Protocol: intraoperative catheter, removal on postoperative day 1, with up to 5 days of epidural analgesia.
Main Results:
- 93 children included (47 pre-protocol, 46 post-protocol).
- Protocol group had fewer catheter reinsertions (2.2% vs 19.1%, p=0.003).
- Catheter removal was faster (1 day vs 3 days, p<0.001) with no increase in UTIs.
Conclusions:
- A standardized urinary catheter protocol can reduce catheter duration.
- Early catheter removal (postoperative day 1) is effective despite ongoing epidural analgesia.
- The protocol decreased postoperative catheter reinsertions in pediatric orthopedic surgery patients.
Background:
Epidural analgesia is commonly used for pain control after major lower-limb orthopedic surgery in children, but it is associated with a risk of postoperative urinary retention. Consequently, urinary catheters are often placed and left in situ for the full duration of epidural analgesia, despite the potential risks of prolonged catheterization, including discomfort, ward reinsertion, and urinary tract infection.
Aims:
To assess the impact of implementing a standardized institutional urinary catheter management protocol on postoperative urinary catheter outcomes in children less than age 18 years, undergoing major lower-limb orthopedic surgery with postoperative epidural analgesia.
Methods:
Single-center, retrospective, observational study on children who met the above criteria in the study period before (1/2019-6/2021) and after (7/2021-7/2023) initiation of a urinary catheter management protocol. The protocol mandated intra-operative urinary catheter placement and early removal on postoperative day 1, while continuing epidural analgesia as long as 5 days.
Results:
A total of 93 children were included in this study: 47 before and 46 after initiation of the protocol. Demographic data were similar. Children treated according to the new protocol required significantly fewer ward urinary catheter insertions (2.2% vs. 19.1% respectively, p = 0.003) and had significantly faster removal of urinary catheter (1 [1-1] vs. 3 [2-3] days, p < 0.001) without subsequent urinary catheter insertion despite similar epidural analgesia duration. There was no difference in occurrence of urinary tract infection.
Conclusions:
Implementation of a standardized institutional urinary catheter management protocol, mandating intraoperative catheter placement and removal on postoperative day 1, despite ongoing epidural analgesia, was associated with reduced urinary catheter duration and fewer postoperative ward catheter insertions in pediatric patients undergoing major lower-limb orthopedic surgery.
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