Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-19T17:16:13.463Z Has data issue: false hasContentIssue false
  • English
  • Français

Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem?

Published online by Cambridge University Press:  02 January 2015

Heidi L. Wald ,
Anne M. Epstein ,
Tiffany A. Radcliff  and
Andrew M. Kramer
Heidi L. Wald*
Affiliation:
Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center, Aurora, Denver, Colorado
Anne M. Epstein
Affiliation:
Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center, Aurora, Denver, Colorado
Tiffany A. Radcliff
Affiliation:
Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center, Aurora, Denver, Colorado Denver Veterans Administration Medical Center, Denver, Colorado
Andrew M. Kramer
Affiliation:
Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center, Aurora, Denver, Colorado
*
Division of Health Care Policy and Research, 13611 E. Colfax Avenue, Suite 100, Aurora, CO 80011 (heidi.wald@uchsc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives.

To explore the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters.

Design.

Retrospective cohort study.

Setting.

US acute care hospitals and skilled nursing facilities.

Patients.

A total of 170,791 Medicare patients aged 65 years or more who were admitted to skilled nursing facilities after discharge from a hospital with a primary diagnosis code indicating major cardiac, vascular, orthopedic, or gastrointestinal surgery in 2001.

Main Outcome Measures.

Patient-specific 30-day rate of rehospitalization for urinary tract infection (UTI) and 30-day mortality rate, as well as the risk of having an indwelling urinary catheter at the time of admission to a skilled nursing facility.

Results.

A total of 39,282 (23.0%) of the postoperative patients discharged to skilled nursing facilities had indwelling urinary catheters. After adjusting for patient characteristics, the patients with catheters had greater odds of rehospitalization for UTI and death within 30 days than patients who did not have catheters. The adjusted odds ratios (aORs) for UTI ranged from 1.34 for patients who underwent gastrointestinal surgery (P <.001) to 1.85 for patients who underwent cardiac surgery (P <.001); the aORs for death ranged from 1.25 for cardiac surgery (P = .01) to 1.48 for orthopedic surgery (P = .002) and for gastrointestinal surgery (P < .001). After controlling for patient characteristics, hospitalization in the northeastern or southern regions of the United States was associated with a lower likelihood of having an indwelling urinary catheter, compared with hospitalization in the western region (P = .002 vs P = .03).

Conclusions.

Extended postoperative use of indwelling urinary catheters is associated with poor outcomes for older patients. The likelihood of having an indwelling urinary catheter at the time of discharge after major surgery is strongly associated with a hospital's geographic region, which reflects a variation in practice that deserves further study.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 2 , February 2008 , pp. 116 - 124
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wells, DL, Saltmarche, A. Voiding dysfunction in geriatric patients with hip fracture: prevalence rate and tentative nursing interventions. Orthop Nurs 1986;5:25–28.Google Scholar
2.Michelson, JD, Lotke, PA, Steinberg, ME. Urinary-bladder management after total joint-replacement surgery. N Engl J Med 1988;319:321–326.Google ScholarPubMed
3.Schaeffer, AJ. Catheter-associated bacteriuria. Urol Clin North Am 1986;13:735.Google Scholar
4.Stamm, WE. Guidelines for prevention of catheter-associated urinary tract infections. Ann Intern Med 1975;82:386.CrossRefGoogle ScholarPubMed
5.Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:68–75.CrossRefGoogle ScholarPubMed
6.Saint, S, Lipsky, B, Goold, S. Urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.Google Scholar
7.Skelly, JM, Guyatt, GH, Kalbfleisch, R, Singer, J, Winter, L. Management of urinary retention after surgical repair of hip fracture. CMAJ 1992;146:1185–1188.Google ScholarPubMed
8.Knight, RM, Pellegrini, JV Jr. Bladder management after total joint arthroplasty. J Arthroplasty 1996;11:882–888.Google Scholar
9.Johansson, I, Athlin, E, Frykholm, L, Bolinder, H, Larsson, G. Intermittent versus indwelling catheters for older patients with hip fractures. J Clin Nurs 2002;11:651–656.Google Scholar
10.Wald, H, Epstein, A, Kramer, A. Extended use of indwelling urinary catheters in postoperative hip fracture patients. Med Care 2005;43:1009–1017.Google Scholar
11.Kramer, AM, Data PRO Project Investigators at the Colorado Foundation for Medical Care, the University of Colorado Health Sciences Center Division of Health Care Policy and Research, Fu Associates, Stepwise Systems. Skilled Nursing Facilities Prospective Payment System Quality Medical Review Data Analysis PRO: Final Report. 7-31-2002. Baltimore, MD: Centers for Medicare and Medicaid Services; 2002.Google Scholar
12.Hawes, C, Morris, JN, Phillips, C, Mor, V, Fries, BE, Nonemaker, S. Reliability estimates for the minimum data set for nursing home resident assessment and care screening (MDS). Gerontologist 1995;35:172–178.Google Scholar
13.Agency for Healthcare Research and Quality. NIS Technical Documentation. 2000. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/ni-sdbdocumentation.jsp. Accessed December 20, 2007.Google Scholar
14.American Medical Directors Association (AMDA). Clinical Practice Guideline: Urinary Incontinence. 1996. Available at: http://www.amda.com/tools/cpg/incontinence.cfm. Accessed December 20, 2007.Google Scholar
15.Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.Google Scholar
16.Lawton, MP, Brody, EM. Assessment of older people: self maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–86.Google Scholar
17.Mahoney, FL, Barthel, DBW. Functional evaluation: the Barthel index. Md State Med J 1965;14:61–65.Google ScholarPubMed
18.Morris, JN, Fries, BE, Mehr, DR, et al.MDS cognitive performance scale. J Gerontol 1994;49: M174–M182.Google Scholar
19.Fish, RH, DataPRO Project Investigators at the Colorado Foundation for Medical Care, the University of Colorado Health Sciences Center Division of Health Care Policy and Research, Fu Associates, Stepwise Systems. Findings from Rehospitalization Transfer within 30 Days Analysis: Summary and Selected Results. Baltimore, MD: Centers for Medicare and Medicaid Services; 2002.Google Scholar
20.Eilertsen, TB, DataPRO Project Investigators at the Colorado Foundation for Medical Care, the University of Colorado Health Sciences Center Division of Health Care Policy and Research, Fu Associates, Stepwise Systems. Findings from Analysis of Residents Discharged to the Community. Baltimore, MD: Centers for Medicare and Medicaid Services; 2002.Google Scholar
21.Carter, MW, Porell, FW. Variations in hospitalization rates among nursing home residents: the role of facility and market attributes. Gerontologist 2003;43:175–191.CrossRefGoogle ScholarPubMed
22.Zimmerman, S, Gruber-Baldini, Ai, Hebel, JR, Sloane, PD, Magaziner, J. Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors. J Am Geriatr Soc 2002;50:1987–1995.Google Scholar
23.Khuri, SF, Daley, J, Henderson, W, et al.Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997;185:315–327.Google ScholarPubMed
24.Daley, J, Khuri, SF, Henderson, W, et al.Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997;185:328–340.Google Scholar
25.Collins, TC, Johnson, M, Daley, J, Henderson, W, Khuri, SF, Gordon, HS. Preoperative risk factors for 30-day mortality after elective surgery for vascular disease in Department of Veterans Affairs hospitals: is race important? J Vase Surg 2001;34:634–640.CrossRefGoogle ScholarPubMed
26.Collins, TC, Daley, J, Henderson, WH, Khuri, SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg 1999;230:251–259.Google Scholar
27.Peterson, ED, Delong, ER, Muhlbaier, LH, et al.Challenges in comparing risk-adjusted bypass surgery mortality: results from the Cooperative Cardiovascular Project. J Am Coll Cardiol 2000;36:2174–2184.Google Scholar
28.Dawson, I, van Bockel, JH. Reintervention and mortality after infrainguinal reconstructive surgery for leg ischemia. Br J Surg 1999;86:38–44.Google Scholar
29.O'Brien, MM, Gonzales, R, Shroyer, AL, et al.Modest serum creatinine elevation affects adverse outcome after general surgery. Kidney Int 2002;62:585–592.Google Scholar
30.Levy, CR, Fish, R, Kramer, AM. Site of death in the hospital versus nursing home among Medicare skilled nursing facility residents admitted under Medicare's Part A Benefit. J Am Geriatr Soc 2004;52:1247–1254.Google Scholar
31.Hanley, JA, McNeil, BJ. The meaning and use of the area under a receiver-operating characteristic (ROC) curve. Radiology 1982;143:29–36.Google Scholar
32.Eilertsen, TB, DataPRO Project Investigators at the Colorado Foundation for Medical Care, University of Colorado Health Sciences Center Division of Health Care Policy and Research, Fu Associates, Stepwise Systems. Rehabilitation Data Flag Analysis. Baltimore, MD: Centers for Medicare and Medicaid Services; 2004.Google Scholar
33.Meyer, G, Lewin, DI, Eisenberg, JM. To err is preventable: medical errors and academic medicine. Am J Med 2001;110:597–603.Google Scholar
34.The Dartmouth Atlas of Health Care in the United States. Chicago: American Hospital Publishing; 1996.Google Scholar
35.Kane, RL, Lin, W, Blewett, LA. Geographic variation in the use of post-acute care. HSR: Health Services Research 2002;37:667–682.Google Scholar
36.US Congress, Office of Technology Assessment. Hip Fracture Outcomes In People Age 50 And Over—Background Paper. OTA-BP-H-120. Washington, DC: US Government Printing Office; 1994.Google Scholar
37.National Center for Health Statistics. National Hospital Discharge Survey. 2000.Google Scholar