Carlock KD, et al. Paper 544. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 22-26, 2022; Chicago.

Carlock KD, et al. Paper 544. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 22-26, 2022; Chicago.

CHICAGO — A higher rate of urinary tract infection and longer length of stay were seen in patients who received routine indwelling catheterization during total hip arthroplasty, according to findings of a retrospective study.

“Our data suggest that routine indwelling urinary catheterization is likely unnecessary for patients undergoing total hip arthroplasty in the setting of spinal anesthetic,” Kurtis D. Carlock, MD, a third-year resident at the University of Washington, said at the American Academy of Orthopaedic Surgeons Annual Meeting.

To study whether the practice of indwelling catheterization for patients undergoing THA and spinal anesthesia could be discontinued, Carlock and colleagues reviewed data for 991 consecutive patients treated by two hip surgeons in a 5-year period. Overall, 498 patients routinely received a Foley catheter and 493 patients did not routinely receive an indwelling catheter.

The protocol for patients with an indwelling catheter was to have it removed 48 hours postoperatively. Ultrasound was used to monitor patients for major or minor postoperative urinary retention (POUR). Researchers defined major POUR as persistent urinary retention despite two straight catheterizations, and they defined minor POUR as retention that resolved with one or two straight catheterizations. In addition, both cohorts were followed for 30 days to check for urinary tract infection (UTI).

Demographics were similar for both cohorts except there “was a higher proportion of female patients among those receiving a urinary catheter,” Carlock said.

“With regard to surgical data, those who did not receive a catheter had a longer surgical time and received a greater volume of intraoperative fluids, and these differences are likely attributable to the highly surgeon-specific nature of the two cohorts,” he said.

Results showed a 1.4% rate of UTI with routine indwelling catheter placement vs. 0% among patients who did not undergo routine catheter placement.

Despite routine catheter use being associated with a significant decrease in the rate of minor POUR, Carlock said, “there was no difference between the groups, however, with respect to the rate of major retention, overall retention or rate of discharge with indwelling catheters.”

Due to a higher rate of UTI and a longer length of stay of about 2.2 days with routine indwelling catheterization, compared with a length of stay of about 1.8 days, the researchers could not recommend routine indwelling catheter placement in this group of THA patients.

“Patients treated at centers with the capability to closely monitor for the development of postop retention are likely well served with adding straight catheterization, given noninferior levels of major retention and a possible reduced rate of UTI compared to routine indwelling catheters,” he said.

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