Trends in Perioperative Catheter Utilization by Surgical Procedure Type in the United States, 2010 – 2017: Evidence from the Nationwide Inpatient Sample

Background Indwelling urethral catheters are regularly used in the operative setting to monitor urinary output, decompress the bladder, or manage post-operative urinary retention. Indwelling urethral catheterization can be associated with significant complications, such as nosocomial infections and urethral trauma, hence the contemporary national and institutional efforts to reduce indwelling urethral catheter usage. Objectives The purpose of this study is to investigate national trends in perioperative catheter usage across surgical procedure categories. Methods This is a retrospective study of adults who received indwelling urethral catheters during elective surgical procedures performed in United States (U.S.) hospitals during 2010-2017. We utilized the National Inpatient Sample (NIS) procedure codes to identify surgical procedure types and insertions of indwelling urethral catheters. Yearly catheterization rates were utilized to assess significant differences in nationwide temporal trends. Results We sampled 81,128,725 perioperative catheterizations across twelve procedure categories. When specific categories were examined separately, the annual proportion of procedures utilizing catheterization decreased for eye (−0.05% [95% CI, -0.10%; -0.02%], p-value 0.013), musculoskeletal (−0.04% [95% CI, -0.09%; 0.003%] p-value 0.063), and urinary system surgeries (−0.54% [95% CI, -0.76%; -0.33%] p-value 0.001). The proportion that utilized urethral catheters increased annually for female reproductive (+0.05% [95% CI, 0.04%; 0.07%] p-value <0.001), male reproductive (+0.31% [95% CI, 0.18%; 0.44%] p-value 0.001), and respiratory system surgeries (0.08% [95% CI, 0.02%; 0.13%] p-value 0.015). When all operative procedures were examined together, the overall annual proportion involving urethral catheterization did not significantly vary during 2010-2017. Conclusion Despite wide dissemination of clinical guidelines and institutional efforts to reduce catheterizations, we observed no significant changes in the overall proportion of all surgical procedures (irrespective of procedure category) that utilized urethral catheters during our study period. ### Competing Interest Statement Dr. Gregory Thoreson actively participates in research in conjunction with the Department of Bioengineering at the Erik Jonsson School of Engineering and Computer Science, University of Texas, Dallas, TX evaluating non invasive alternatives for indwelling urethral catheter use. No financial compensation exists for this research. ### Funding Statement The statistical analysis of this study was funded in part by research priority funding from the Baylor Scott & White Dallas Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Surgical Research Peer Review Committee of the Department of Surgery at Baylor University Medical Center reviewed the proposal and recommended that it be granted IRB approval under the Department of Surgery umbrella IRB protocol. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.