Urinary Catheter Utility in Laparoscopic Appendectomy: The Risk of Catheter-Associated Urinary Tract Infections (CAUTIs)

Author(s):
Charoo Piplani; Jennifer E. Geller; Sorasicha Nithikasem; George A. Hung; Amanda Teichman; Philip Barie; Mayur Narayan; Rachel Choron

Background:

CAUTIs account for 1 million cases of nosocomial infections annually in the United States, and 75% of all hospital-acquired UTIs. A risk factor for CAUTI is prolonged urinary catheter (UC) use, therefore transient UC during laparoscopic appendectomy (LA), a common practice to avoid iatrogenic bladder injury, is believed to be safe. However, data on the incidence of CAUTIs following LA or their avoidance are limited.

Hypothesis:

Patients who underwent UC for LA developed more post-operative CAUTIs than patients without UC (noUC), without effect on the incidence of bladder injury.

Methods:

Retrospective analysis of patients >21 years who underwent LA (2016-2023). Primary outcome was postoperative CAUTI in UC vs. noUC patients. CAUTI was defined as symptoms or urinalysis findings compatible with UTI within 30 days from LA. Secondary outcomes included bladder injury, catheter–related complications, time until CAUTI diagnosis, and antibiotic exposure. Statistics: Mann–Whitney U and Fisher exact tests;α=0.05.

Results:

Among 981 LA, there were 678 UC and 303 noUC. A majority was male (56%) and young [38 years, IQR 28-50]. Duration of catheterization was 102 minutes [IQR 85-123] whereas duration of surgery was 58 minutes [IQR 44-80]. There were more catheter-related complications in the UC vs. noUC group (10 [1.5%] vs 0; p=0.04). The incidence of CAUTI was 0.5%, with 5 cases (0.7%) after UC and zero for noUC (p=0.34). CAUTIs were detected at 11 days postoperatively [IQR 6-17] and treated with antibiotics for 5 days [IQR 5-13]; nitrofurantoin, penicillins, and sulfonamides were the most common antimicrobial therapies. 4 UC patients had urinary retention (2 required re-catheterization and discharge with an indwelling catheter). One UC “urinary retainer” developed a CAUTI and required hospital readmission for the CAUTI. There was no urinary retention in the noUC group. There were no bladder injuries.

Conclusions:

The incidence of CAUTIs was low following LA and bladder injuries were non-existent. As catheter–related complications were higher among the UC group and there were no episodes of urinary retention, post-operative catheterization, or bladder injury in the noUC group, we suggest the omission of UC for LA.