Using appropriateness criteria to identify opportunities to improve perioperative urinary catheter use

Am J Surg. 2020 Sep;220(3):706-713. doi: 10.1016/j.amjsurg.2020.01.008. Epub 2020 Jan 10.


Background: The Michigan Appropriate Perioperative (MAP) criteria provide guidance regarding urinary catheter use. For Category A (e.g., laparoscopic cholecystectomy), B (e.g., hemicolectomy), and C (e.g., abdominoperineal resection) procedures, recommendations are to avoid catheter, remove POD 0 or 1, and remove POD 1-4, respectively. We applied MAP criteria to statewide registry data to identify improvement targets.

Methods: Retrospective cohort study of risk-adjusted catheter use and duration for appendectomy, cholecystectomy, and colorectal resections in 2014-2015 from 64 Michigan hospitals.

Results: 5.5% of 13,032 Category A cases used urinary catheters, including 26.9% of open appendectomies. 94.5% of 1,624 Category B cases used catheters (31.2% remained after POD 1). 98.3% of 700 Category C cases used catheters (4.6% remained POD5+). Variation in duration of use persisted after risk adjustment.

Conclusions: Perioperative urinary catheter use was appropriate for most simple abdominal procedures, but duration of use varied in all categories.

Keywords: Appropriateness; General surgery; Patient safety; Perioperative care; Urinary catheter.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Appendectomy
  • Cholecystectomy
  • Cohort Studies
  • Digestive System Surgical Procedures
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Procedures and Techniques Utilization / standards*
  • Procedures and Techniques Utilization / statistics & numerical data*
  • Retrospective Studies
  • Urinary Catheterization / standards*
  • Urinary Catheterization / statistics & numerical data*