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National Incidence and Impact of Non-Infectious Urethral

Catheter Related Complications on the Surgical Care

Improvement Project

David S. Aaronson, * Alex K. Wu, Sarah D. Blaschko, Jack W. McAninch

and Maurice Garcia

From the Department of Urology, University of California San Fransisco, San

Fransisco ( DSA, AKW, SDB, JBM, MG ), and Kaiser Permanente Medical Group,Oakland ( DSA ), California

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Non-infection urethral catheter related

complications has received little national

attention although they are well documented in

medical literature. We need the training and protocol to prevent

non-infection urethral catheter related

complications.

Kashefi et all : rate of catheter related

complication to be 0,3 % for male ward patients

and decreased to 0,07 % after an educational

intervention direct to nurses.

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Materials and Methods

Cross sectional study of USA inpatients in 2007that have 1 of the 7 surgical Procedures ( byJoint Commissions Surgical Care ImprovementProject ).

Location : Nonfederal hospitals in 40 states.

Sample identified through ICD-9 CM :

- Long of stay (LOS)

- Mortality Rate.- UTI ( not focused in this study ).

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Total cases of the 7 procedurals : 416.389

cases.

Number of identified complications : 289

cases.

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Inclusion criterias :

- ICD-9 CM

Exclusion criterias :-Patients younger than 18 years old.

- No length of stay.

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Results

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Table 1 :

On average noninfectious urethral catheter

related complications occurred in older

patients ( p< 0,0001).

Men more than women.

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Range :

Major vascular surgery = 1 : 685

Hysterectomy = 1 : 2467.

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1. Univariant Analysis

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1. Univariant analysis :

LOS ( 11,7 to 15,1 days ) is increased in 6

procedurals ( 1,5 to 3 days ) except Non-CABG .

Incidence of UTI is increased in 5 procedurals. CABG and non-CABG did not have significant

increased in UTI rates.

Mortality rates of patients did not show statistically

significant difference for all procedurals if they did ordid notexperience of urethral catheter related

complications.

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2. Multivariant Linear Regression :

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2. Multivariant Linear Regression :

- LOS is increased in 5 procedurals except

Non-CABG and Knee surgery ( 1,5 to 3,5

days).

- No increased of mortality rate in 7

procedurals.

- Odds ratio to development of UTI is increasedfor 6 procedurals except Non-CABG ( 2,5 to

6,8 ).

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Discussions

Urethral catheterization is moderate invasifeprocedure.

Catheter related complication trend to increased

LOS and UTI, with long term consequencessuch as urethral stricture, bleeding, pain andalways increased of hospitalized cost.

Older men is the highest risk of for this

complication especially in ERurethralcatheterization must performed by experiencednurse or who had have a medical training.

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Some factors that have an effect on

urethral catheterization complications :

Anatomy of urethral / prostate

Underfilling of the balloon

Fixation of catheter can prevent the traction

when the patient moved.

Surgery / radiation procedure on pelvic.

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Conclussions

Urethral catheter related complications

can increased LOS.

The consequences is bleeding, stricture,

pain, and cost of inpatient hospitalized.

We can prevent the urethral catheter

related complications by prepare the

protocol or any trainning for nurse or

health proffesionals.

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Thank You

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7 Procedural Operations

Coronary Artery Bypass Grafting (CABG)

Major Vascular surgery ( aneurism repair,thromboendarterectomy, vein bypass)

Hip arthroplasty

Knee arthroplasty

Hysterectomy

Other Cardiac surgery

Colon surgery

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ICD-9 CM

Urethral false passage (599.4)

Mechanical injury due to Indwellingcatheter (996.31)

Other mechanical complication due togenito urinary device (996.39)

Other complications due to genito urinary

device, implant and graft (996.76) Surgical misadventure as a result of

urethral catheterization(E879.6)