Trends in Perioperative Urinary Catheter Utilization by Surgical Procedure Type in the United States, 2010-2017: Evidence From the Nationwide Inpatient Sample.

Abstract

Urinary catheters are frequently used in perioperative care, yet their overuse contributes to iatrogenic complications including catheter-associated urinary tract infections (CAUTIs) and urethral trauma. In response, the Centers for Disease Control and Prevention (CDC) issued guidelines in 2009 to minimize inappropriate perioperative catheter use. This study evaluates national trends in perioperative indwelling urethral catheter utilization across various surgical specialties from 2010 to 2017 using the Nationwide Inpatient Sample database (NIS). We conducted a retrospective analysis of elective surgical admissions from the NIS database, including patients ≥ 18 years undergoing surgery with associated ICD codes for urethral catheterization. Proportional catheter utilization was calculated annually per surgical type. Mann-Kendall τ trend tests and locally estimated scatterplot smoothing (LOESS) models assessed temporal trends. Statistical significance was set at p < 0.05. Over the 8-year period, 81,128,725 procedures involving perioperative catheterization were recorded. Significant reductions in perioperative catheter use occurred in eye (-0.05%, p = 0.013) and urinary system surgical procedures (-0.54%, p = 0.001). Conversely, increases were observed in female reproductive (0.05%, p < 0.001), male reproductive (0.31%, p < 0.001), and respiratory surgical procedures (0.08%, p = 0.015). No significant overall change was found across all surgical categories combined (p = 0.873). Despite national guidelines, overall perioperative catheter use has not significantly declined. Subspecialty variation suggests that adherence to catheter stewardship may be influenced by procedural norms and surgical specialty-specific practices. Enhanced protocol-driven approaches, particularly nurse-led catheter removal and integration into ERAS pathways, warrant broader implementation.