Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data

Arch Surg. 2008 Jun;143(6):551-7. doi: 10.1001/archsurg.143.6.551.


Objectives: To describe the frequency and duration of perioperative catheter use and to determine the relationship between catheter use and postoperative outcomes.

Design: Retrospective cohort study.

Setting: Two thousand nine hundred sixty-five acute care US hospitals.

Patients: Medicare inpatients (N = 35 904) undergoing major surgery (coronary artery bypass and other open-chest cardiac operations; vascular surgery; general abdominal colorectal surgery; or hip or knee total joint arthroplasty) in 2001. Main Outcome Measure Postoperative urinary tract infection.

Results: Eighty-six percent of patients undergoing major operations had perioperative indwelling urinary catheters. Of these, 50% had catheters for longer than 2 days postoperatively. These patients were twice as likely to develop urinary tract infections than patients with catheterization of 2 days or less. In multivariate analyses, a postoperative catheterization longer than 2 days was associated with an increased likelihood of in-hospital urinary tract infection (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41) and 30-day mortality (parameter estimate, 0.54; 95% CI, 0.37-0.72) as well as a decreased likelihood of discharge to home (parameter estimate, - 0.57; 95% CI, - 0.64 to - 1.51).

Conclusions: Indwelling urinary catheters are routinely in place longer than 2 days postoperatively and may result in excess nosocomial infections. The association with adverse outcomes makes postoperative catheter duration a reasonable target of infection control and surgical quality-improvement initiatives.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Catheters, Indwelling / adverse effects
  • Catheters, Indwelling / microbiology
  • Catheters, Indwelling / statistics & numerical data*
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Population Surveillance / methods*
  • Postoperative Care / methods*
  • Postoperative Period
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control*
  • Time Factors
  • United States / epidemiology
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / prevention & control*