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.