Impact of Enhanced Recovery Pathways and early urinary catheter removal on post-operative urinary retention.

Post-operative urinary retention (POUR) is a common complication after colorectal surgery. Enhanced recovery pathways (ERP) typically include early catheter removal but may place patients at risk for POUR.

This is a retrospective cohort analysis of patients undergoing colorectal surgery at a single institution between April 2014 and November 2017. Patients were stratified into non-ERP and ERP cohorts and post-operative outcomes were compared.

Of 284 patients studied, ERP was applied to 161 (57%) while the remaining 123 (43%) recovered under standard care. Median duration of indwelling Foleys was 1 day for ERP and 2 days for non-ERP patients (p < 0.001). ERP patients experienced higher rates of straight catheterization (22% vs 12%,p = 0.036), Foley reinsertion (14% vs 7%,p = 0.07), and initiation of alpha antagonists (12% vs 5%,p = 0.04). Significant independent predictors of POUR were age (OR 1.03, p = 0.002), male gender (OR 2.79, p = 0.001), surgery duration (OR 1.27, p = 0.027), and ERP (OR 1.96, p = 0.025).

ERP following colorectal surgery that include routine early Foley catheter removal on post-operative day one is associated with increased rates of POUR; however, this did not lead to increased rates of catheter-associated urinary tract infections during the index admission in the population studied.

American journal of surgery. 2020 Jul 01 [Epub ahead of print]

Vernissia Tam, Waseem Lutfi, Katrina Morgan, Robin Vasan, Robin Scaife, Brandon Mahler, David S Medich, James P Celebrezze, Andrew R Watson, Jennifer Holder-Murray

Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Sanger Heart and Vascular Institute, Charlotte, NC, USA., Division of Colon and Rectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Colon and Rectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Colon and Rectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: .