Wald Heidi L, Epstein Anne M, Radcliff Tiffany A, Kramer Andrew M
Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, USA.
Infect Control Hosp Epidemiol. 2008 Feb;29(2):116-24. doi: 10.1086/526433.
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.
Retrospective cohort study.
US acute care hospitals and skilled nursing facilities.
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.
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.
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).
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.
探讨在专业护理机构中，心脏、血管、胃肠道或骨科手术后老年患者术后长期留置导尿管与预后之间的关系，并描述与长期留置导尿管相关的患者及医院特征。
回顾性队列研究。
美国急症护理医院和专业护理机构。
2001年，共有170791名65岁及以上的医疗保险患者，他们在医院出院后入住专业护理机构，其主要诊断代码表明曾接受重大心脏、血管、骨科或胃肠道手术。
患者特异性的30天因尿路感染（UTI）再次住院率和30天死亡率，以及入住专业护理机构时留置导尿管的风险。
共有39282名（23.0%）术后出院至专业护理机构的患者留置了导尿管。在对患者特征进行调整后，留置导尿管的患者在30天内因UTI再次住院和死亡的几率高于未留置导尿管的患者。UTI的调整后优势比（aORs）范围为：接受胃肠道手术的患者为1.34（P<0.001），接受心脏手术的患者为1.85（P<0.001）；死亡的aORs范围为：心脏手术患者为1.25（P = 0.01），骨科手术患者为1.48（P = 0.002），胃肠道手术患者为1.48（P<0.001）。在控制患者特征后，与西部地区住院相比，在美国东北部或南部地区住院的患者留置导尿管的可能性较低（P = 0.002对P = 0.03）。
术后长期使用留置导尿管与老年患者的不良预后相关。大手术后出院时留置导尿管的可能性与医院所在地理区域密切相关，这反映了一种值得进一步研究的实践差异。
