De León Luis E, Patil Namrata, Hartigan Philip M, White Abby, Bravo-Iñiguez Carlos E, Fox Sam, Tarascio Jeffrey, Swanson Scott J, Bueno Raphael, Jaklitsch Michael T
Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Surg Res (Houst). 2020;3(3):163-171. doi: 10.26502/jsr.10020068. Epub 2020 Jun 22.
Current quality guidelines recommend the removal of urinary catheters on or before postoperative day two, to prevent catheter-associated urinary tract infections (CAUTI). The goal of this study was to evaluate the impact urinary catheter removal on the need for urinary recatheterization (UR) of patients with epidural anesthesia undergoing thoracic surgery.
All patients undergoing thoracic surgery between November 4, 2017 and January 9, 2018 who had a urinary catheter placed at the time of intervention were prospectively evaluated. Patient characteristics including: history of benign prostatic hyperplasia (BPH), catheter related variables and rates of UR were collected through chart review and daily visits to the wards. BPH was defined as history of transurethral resection of the prostate or treatment with selective α-adrenergic receptor antagonists.
Over a two-month period 267 patients were included, 124 (46%) were male. Epidural catheters were placed in 88 (33%) patients. Median duration of urinary catheters for the cohort was 1 day (0 days - 18 days), and it was significantly higher in patients with epidural anesthesia (Table 1). Overall 20 (7%) patients required UR. On initial analysis, there was no statistical difference in the rate of UR among patients with and without epidural catheters [9/88 (10%) vs 11/179 (6%), p=0.23). The rate of UR was higher in males than in females (14/124 (11%) vs 6/143 (4%), p=0.03). Fifteen (12%) patients had a diagnosis of BPH. The rate of UR was three-times higher in this group than in those without BPH [4/15 (27%) vs 10/109 (9%) p=0.05]. Four (1%) patients developed a CAUTI during follow-up, and the rate of CAUTI was not different between those with and without epidural catheters.
Urinary catheters in patients with thoracic epidural anesthesia can be safely removed, as evidenced by low reinsertion and infection rates. Removal of urinary catheters in patients with a history of BPH should be carefully evaluated, as over 1/4 will require urinary recatheterization in this subgroup. Further study of this group is needed to avoid unnecessary patient discomfort associated with recatheterization.
当前的质量指南建议在术后第二天或之前拔除导尿管，以预防导尿管相关的尿路感染（CAUTI）。本研究的目的是评估拔除导尿管对接受胸外科手术的硬膜外麻醉患者再次导尿（UR）需求的影响。
对2017年11月4日至2018年1月9日期间所有接受胸外科手术且在干预时放置了导尿管的患者进行前瞻性评估。通过病历审查和每日查房收集患者特征，包括：良性前列腺增生（BPH）病史、与导尿管相关的变量以及UR发生率。BPH定义为经尿道前列腺切除术史或使用选择性α-肾上腺素能受体拮抗剂治疗史。
在两个月的时间里纳入了267例患者，其中124例（46%）为男性。88例（33%）患者放置了硬膜外导管。该队列中导尿管的中位留置时间为1天（0天 - 18天），在硬膜外麻醉患者中显著更长（表1）。总体而言，20例（7%）患者需要再次导尿。初步分析显示，有和没有硬膜外导管的患者再次导尿率无统计学差异[9/88（10%）对11/179（6%），p = 0.23]。男性的再次导尿率高于女性（14/124（11%）对6/143（4%），p = 0.03）。15例（12%）患者诊断为BPH。该组的再次导尿率是无BPH组的三倍[4/15（27%）对10/109（9%），p = 0.05]。4例（1%）患者在随访期间发生了CAUTI，有和没有硬膜外导管的患者CAUTI发生率无差异。
胸段硬膜外麻醉患者的导尿管可以安全拔除，再次插入率和感染率较低证明了这一点。有BPH病史患者的导尿管拔除应仔细评估，因为该亚组中超过四分之一的患者需要再次导尿。需要对该组进行进一步研究，以避免与再次导尿相关的不必要的患者不适。
