The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients

Abstract

Objectives: To determine the association between indwelling urinary catheterization without a specific medical indication and adverse outcomes.

Design: Prospective cohort.

Setting: General medical inpatient services at a teaching hospital.

Participants: Five hundred thirty-five patients aged 70 and older admitted without a specific medical indication for urinary catheterization.

Intervention: Indwelling urinary catheterization within 48 hours of admission.

Measurements: Death, length of hospital stay, decline in ability to perform activities of daily living (ADLs), and new admission to a nursing home.

Results: Indwelling urinary catheters were placed in 76 of the 535 (14%) patients without a specific medical indication. Catheterized patients were more likely to die in the hospital (6.6% vs 1.5% of those not catheterized, P=.006) and within 90 days of hospital discharge (25% vs 10.5%, P<.001); the greater risk of death with catheterization persisted in a propensity-matched analysis (hazard ratio (HR)=2.42, 95% confidence interval (CI)=1.04-5.65). Catheterized patients also had longer lengths of hospital stay (median, 6 days vs 4 days; P=.001); this association persisted in a propensity-matched analysis (HR=1.46, 95% CI=1.03-2.08). Catheterization was not associated (P>.05) with decline in ADL function or with admission to a nursing home.

Conclusion: In this cohort of older patients, urinary catheterization without a specific medical indication was associated with greater risk of death and longer hospital stay.