A systematic review and meta-analysis of the timing of indwelling catheter extubation in patients undergoing gynecological and obstetric surgery.

Abstract

The timing of urinary catheter removal after gynecological and obstetric surgery remains controversial. This meta-analysis investigated the optimal timing of urinary catheter removal. The PubMed, Ovid Medline, Cochrane, and Embase databases were searched for literatures published between 2010 and 2021 relating to randomized controlled studies examining the timing of catheter removal. The modified Joanna Briggs Institute (JBI) scoring criteria was used to assess the quality of the literatures. After extracting the literature data, the Revman 5.3 software was used for analysis and to obtain the statistical forest plots. A total of 345 literatures were screened and 11 literatures were finally included. Meta-analysis showed that there was no statistical difference in the occurrence of urinary tract infection (UTI) rate between extubation at 6 hours and immediately after surgery [odds ratio (OR) =1.66; 95% confidence interval (CI): 0.58 to 4.81; P=0.35], but the urinary retention rate was significantly lower in patients who were extubated at 6 hours post-surgery compared to immediately after surgery (OR =0.06; 95% CI: 0.01 to 0.36; P=0.002). In patients who were extubated at 12 hours post-operation, the rate of UTI was significantly higher than immediate extubation post-operation (OR =2.32; 95% CI: 1.31 to 4.10; P=0.004), while the probability of urinary retention was significantly lower than extubated immediate (OR =0.18; 95% CI: 0.04 to 0.83; P=0.03). Similarly, in patients who were extubated at 24 hours post-operation, the UTI rate was significantly higher than that patients who were immediately extubated (OR =4.51; 95% CI: 2.02 to 10.09; P=0.0002) and the urinary retention rate was significantly lower than extubated immediately (OR =0.06; 95% CI: 0.01 to 0.32; P=0.001). The UTI rate of patients who were extubated 48 hours after surgery was not significantly different from that of patients extubated 24 hours after surgery (OR =1.62; 95% CI: 0.76 to 3.45; P=0.21) and the incidence of urinary retention was not significantly different (OR =0.28; 95% CI: 0.07 to 1.18; P=0.08). The optimal time for removal of the urinary catheter is 6 hours after gynecological and obstetric surgery.