Okrainec Allan, Aarts Mary-Anne, Conn Lesley Gotlib, McCluskey Stuart, McKenzie Marg, Pearsall Emily A, Rotstein Ori, Victor J Charles, McLeod Robin S
Department of Surgery, University Health Network, Toronto, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
J Gastrointest Surg. 2017 Aug;21(8):1309-1317. doi: 10.1007/s11605-017-3434-x. Epub 2017 May 25.
The objective of the study was to determine whether compliance with Enhanced Recovery after Surgery (ERAS) urinary catheter recommendations is associated with decreased urinary tract infections (UTI) and length of stay (LOS).
Patients having colorectal surgery at 15 academic hospitals were included. Patient and outcome data were collected prospectively. The guideline recommends that urinary catheters following colonic and rectal procedures should be removed at or before 24 and 72 h, respectively.
Two thousand nine hundred and twenty-seven patients (1397 females and 1522 males; mean age 60.3 years) were enrolled. Small bowel or colonic procedures were performed in 1897 (64.9%) and rectal procedures in 1030 (35.2%) patients. Overall, 53.2% of patients had their catheter removed in compliance with the guidelines (44.3% after colonic resections and 69.5% after rectal resections). Following colonic operations, 0.8% of patients who were guideline compliant had a UTI compared to 4.1% non-compliant patients (RR 0.20, 95% CI 0.07-0.58; p = 0.003). Following rectal operations, 3.5% of patients who were guideline compliant had a UTI compared to 9.6% of patients who were non-compliant (RR 0.37, 95% CI 0.20-0.68; p = 0.001). Median LOS was decreased in compliant patients: 4 vs 5 days following colonic procedures (RR 0.73, 95% CI 0.66-0.82; p < 0.0001) and 5 vs 8 days following rectal procedures (RR 0.54, 95% CI 0.49-0.59; p < 0.001).
Early removal of urinary catheters is associated with a decreased risk of UTI and LOS.
本研究的目的是确定遵循术后加速康复（ERAS）导尿管建议是否与降低尿路感染（UTI）风险及缩短住院时间（LOS）相关。
纳入15家学术医院接受结直肠手术的患者。前瞻性收集患者及预后数据。该指南建议，结肠和直肠手术后的导尿管应分别在24小时及以内或72小时及以内拔除。
共纳入2927例患者（1397例女性和1522例男性；平均年龄60.3岁）。1897例（64.9%）患者接受小肠或结肠手术，1030例（35.2%）患者接受直肠手术。总体而言，53.2%的患者按照指南拔除了导尿管（结肠切除术后为44.3%，直肠切除术后为69.5%）。结肠手术后，遵循指南的患者中有0.8%发生UTI，而未遵循指南的患者中这一比例为4.1%（相对危险度0.20，95%置信区间0.07 - 0.58；p = 0.003）。直肠手术后，遵循指南的患者中有3.5%发生UTI，而未遵循指南的患者中这一比例为9.6%（相对危险度0.37，95%置信区间0.20 - 0.68；p = 0.001）。遵循指南的患者住院时间中位数缩短：结肠手术后为4天对5天（相对危险度0.73，95%置信区间0.66 - 0.82；p < 0.0001），直肠手术后为5天对8天（相对危险度0.54，95%置信区间0.49 - 0.59；p < 0.001）。
早期拔除导尿管与降低UTI风险及缩短LOS相关。
