Abstract
BackgroundEpidural catheters are state of the art for postoperative analgesic in abdominal surgery. Due to neurolysis it can lead to postoperative urinary tract retention (POUR), which leads to prolonged bladder catheterization, which has an increased risk for urinary tract infections (UTI). Our aim was to identify the current perioperative management of urinary catheters and, second, to identify the optimal time of suprapubic bladder catheter removal in regard to the removal of the epidural catheter.MethodsWe sent a questionnaire to 102 German hospitals and analyzed the 83 received answers to evaluate the current handling of bladder drainage and epidural catheters. Then, we conducted a retrospective study including 501 patients, who received an epidural and suprapubic catheter after abdominal surgery at the University Hospital Würzburg. We divided the patients into three groups according to the point in time of suprapubic bladder drainage removal in regard to the removal of the epidural catheter and analyzed the onset of a UTI.ResultsOur survey showed that in almost all hospitals (98.8%), patients received an epidural catheter and a bladder drainage after abdominal surgery. The point in time of urinary catheter removal was equally distributed between before, simultaneously and after the removal of the epidural catheter (respectively: ~28–29%). The retrospective study showed a catheter-associated UTI in 6.7%. Women were affected significantly more often than men (10,7% versus 2,5%, p<0.001). There was a non-significant trend to more UTIs when the suprapubic catheter was removed after the epidural catheter (before: 5.7%, after: 8.4%).ConclusionThe point in time of suprapubic bladder drainage removal in relation to the removal of the epidural catheter does not seem to correlate with the rate of UTIs. The current handling in Germany is inhomogeneous, so further studies to standardize treatment are recommended.
Highlights
In Germany, approximately 16 million operations are performed every year, which include 2.5 million abdominal operations [1]
Due to neurolysis it can lead to postoperative urinary tract retention (POUR), which leads to prolonged bladder catheterization, which has an increased risk for urinary tract infections (UTI)
There was a non-significant trend to more UTIs when the suprapubic catheter was removed after the epidural catheter
Summary
In Germany, approximately 16 million operations are performed every year, which include 2.5 million abdominal operations [1]. The epidural catheter is the state of the art postoperative pain therapy [2,3]. High-dose epidurals using bupivacaine 0,25% have been shown to be associated with a rate for postoperative urinary tract retention (POUR) of up to 33% [5]. The risk for urinary tract retention leads to routine bladder catheterization, which itself is associated with a higher incidence of catheterassociated urinary tract infections (UTI) [6]. A retrospective study comparing patients after rectum resection with a transurethral or suprapubic catheter showed similar infection rates (5.6 vs 5.8%) [13]. Epidural catheters are state of the art for postoperative analgesic in abdominal surgery. Due to neurolysis it can lead to postoperative urinary tract retention (POUR), which leads to prolonged bladder catheterization, which has an increased risk for urinary tract infections (UTI). Our aim was to identify the current perioperative management of urinary catheters and, second, to identify the optimal time of suprapubic bladder catheter removal in regard to the removal of the epidural catheter
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