Wald et al reported a retrospective cohort study of 35,904 Medicare patients from 2,965 United States acute care hospitals who underwent major surgery (coronary artery bypass and other open cardiac operations, vascular surgery, general abdominal colorectal surgery, hip or knee joint arthroplasty) during 2001. Eighty six percent of patients undergoing these major operations had perioperative indwelling urinary catheters. Of these, 50% had their catheters for longer than 2 days post operatively. Those patients with catheters for more than 2 days were twice as likely to a develop urinary tract infection than patients with catheterization of 2 days or less. In addition post operative catheterization greater than 2 days was also associated with increased 30 day mortality, and decreased likelihood to be discharged home. In their introduction the authors note that the risk of urinary tract infection is 5 to 10% per catheter day beyond the first 48 hours. In their discussion the authors note that “among patients with urinary tract infection an estimated 3.6% will develop bacteremia – a condition that adds significantly to length of stay, and is a risk factor for death among elderly patients.” Wald HL et al: Indwelling urinary catheter use in the postoperative period. Analysis of the National Surgical Infection Prevention Project Data. Arch Surg 2008;143:551-557
David S. Smith, M.D., Ph.D.